- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,288.25 / $2,041.74
| Facility | | $416.87 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $616.60
| Professional | | $331.13 | $398.11 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $3,548.13
| Facility | | $2,630.27 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $524.81
| Professional | | $389.05 | $389.05 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $2,398.83
| Facility | | $489.78 | $512.86 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $478.63 / $645.65
| Professional | | $338.84 | $478.63 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,819.70 / $7,079.46
| Facility | | $812.83 | $1,819.70 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $660.69
| Professional | | $316.23 | $426.58 | $660.69 |