- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,454.71 / $6,606.93
| Facility | | $758.58 | $2,454.71 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $891.25
| Professional | | $436.52 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $776.25
| Professional | | $489.78 | $645.65 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,479.11 / $5,128.61
| Facility | | $512.86 | $1,479.11 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $562.34 / $3,467.37
| Professional | | $416.87 | $562.34 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,187.76 / $4,073.80
| Facility | | $575.44 | $2,187.76 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $741.31
| Professional | | $398.11 | $512.86 | $741.31 |