- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,479.11 / $3,890.45
| Facility | | $691.83 | $1,479.11 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $691.83 / $1,258.93
| Professional | | $562.34 | $691.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,096.48 / $3,890.45
| Facility | | $758.58 | $1,096.48 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $1,513.56
| Professional | | $338.84 | $575.44 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $1,584.89 / $3,548.13
| Facility | | $549.54 | $1,584.89 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $977.24 / $2,041.74
| Professional | | $389.05 | $977.24 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $851.14 / $1,023.29
| Facility | | $512.86 | $851.14 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,023.29
| Professional | | $354.81 | $512.86 | $1,023.29 |