- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.30 / $693.58 / $1,663.51
| Facility | | $520.30 | $693.58 | $1,663.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.75 / $448.43 / $719.07
| Professional | | $358.75 | $448.43 | $719.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.91 / $3,776.48 / $7,386.18
| Facility | | $597.91 | $3,776.48 | $7,386.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.05 / $364.72 / $5,031.79
| Professional | | $269.05 | $364.72 | $5,031.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.98 / $598.51 / $2,181.73
| Facility | | $392.98 | $598.51 | $2,181.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.43 / $692.14 / $1,222.63
| Professional | | $332.43 | $692.14 | $1,222.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.04 / $591.92 / $807.18
| Professional | | $275.04 | $591.92 | $807.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.14 / $358.75 / $1,059.20
| Professional | | $82.14 | $358.75 | $1,059.20 |