- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.82 / $964.14 / $2,031.91
| Facility | | $601.82 | $964.14 | $2,031.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $543.66 / $679.57
| Professional | | $407.74 | $543.66 | $679.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.62 / $750.92 / $2,351.31
| Facility | | $657.62 | $750.92 | $2,351.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.83 / $352.01 / $827.48
| Professional | | $271.83 | $352.01 | $827.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.40 / $1,120.86 / $1,881.43
| Facility | | $468.40 | $1,120.86 | $1,881.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.55 / $780.98 / $1,154.02
| Professional | | $397.55 | $780.98 | $1,154.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.42 / $407.74 / $815.48
| Professional | | $285.42 | $407.74 | $815.48 |