- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,258.93 / $1,862.09
| Facility | | $616.60 | $1,258.93 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $776.25 / $1,479.11
| Professional | | $645.65 | $776.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,235.94 / $4,365.16
| Facility | | $2,691.53 | $3,235.94 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $812.83 / $1,071.52
| Professional | | $537.03 | $812.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,584.89
| Professional | | $630.96 | $870.96 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $1,548.82
| Facility | | $251.19 | $588.84 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $1,318.26
| Professional | | $537.03 | $741.31 | $1,318.26 |