- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $1,949.84
| Facility | | $354.81 | $660.69 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $851.14
| Professional | | $323.59 | $426.58 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,230.27 / $3,981.07
| Facility | | $363.08 | $1,230.27 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $446.68 / $954.99
| Professional | | $239.88 | $446.68 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,230.27 / $3,890.45
| Facility | | $346.74 | $1,230.27 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $616.60 / $1,202.26
| Professional | | $323.59 | $616.60 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,949.84 / $3,981.07
| Facility | | $977.24 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $977.24
| Professional | | $309.03 | $467.74 | $977.24 |