- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.81 / $611.51 / $1,180.38
| Facility | | $501.81 | $611.51 | $1,180.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.22 / $504.16 / $644.65
| Professional | | $416.22 | $504.16 | $644.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.00 / $1,479.00 / $3,048.19
| Facility | | $1,062.00 | $1,479.00 | $3,048.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.46 / $505.15 / $775.74
| Professional | | $343.46 | $505.15 | $775.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,768.66 / $2,280.05 / $4,553.84
| Facility | | $1,768.66 | $2,280.05 | $4,553.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.01 / $1,297.44 / $1,853.58
| Professional | | $1,040.01 | $1,297.44 | $1,853.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.53 / $1,216.58 / $1,676.99
| Facility | | $873.53 | $1,216.58 | $1,676.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.76 / $475.25 / $735.22
| Professional | | $352.76 | $475.25 | $735.22 |