- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $2,951.21
| Facility | | $537.03 | $1,096.48 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $851.14
| Professional | | $426.58 | $501.19 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $758.58 / $2,630.27
| Facility | | $575.44 | $758.58 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $380.19 / $1,122.02
| Professional | | $288.40 | $380.19 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,122.02 / $2,630.27
| Facility | | $380.19 | $1,122.02 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $707.95 / $1,380.38
| Professional | | $331.13 | $707.95 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $575.44 / $741.31
| Facility | | $288.40 | $575.44 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $812.83
| Professional | | $245.47 | $346.74 | $812.83 |