- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,479.11 / $3,890.45
| Facility | | $660.69 | $1,479.11 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $776.25 / $1,148.15
| Professional | | $478.63 | $776.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,318.26 / $2,951.21
| Facility | | $478.63 | $1,318.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,288.25 / $1,905.46
| Professional | | $645.65 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $831.76 / $1,621.81
| Facility | | $616.60 | $831.76 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $562.34 / $2,454.71
| Professional | | $288.40 | $562.34 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,318.26 / $1,318.26
| Facility | | $467.74 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $562.34 / $1,096.48
| Professional | | $288.40 | $562.34 | $1,096.48 |