- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.18 / $983.02 / $2,364.79
| Facility | | $693.18 | $983.02 | $2,364.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.03 / $441.97 / $1,184.08
| Professional | | $158.03 | $441.97 | $1,184.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.51 / $898.72 / $1,862.04
| Facility | | $563.51 | $898.72 | $1,862.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $437.60 / $1,028.75
| Professional | | $136.04 | $437.60 | $1,028.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.56 / $372.27 / $676.27
| Facility | | $105.56 | $372.27 | $676.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.00 / $1,368.00 / $1,368.00
| Professional | | $1,368.00 | $1,368.00 | $1,368.00 |