- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,073.80 / $7,762.47
| Facility | | $512.86 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $660.69
| Professional | | $416.87 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $645.65 / $3,235.94
| Professional | | $295.12 | $645.65 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $1,348.96
| Professional | | $524.81 | $707.95 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $562.34 / $1,230.27
| Professional | | $537.03 | $562.34 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,548.82
| Facility | | $213.80 | $549.54 | $1,548.82 |