- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.04 / $1,162.41 / $2,374.83
| Facility | | $704.04 | $1,162.41 | $2,374.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.39 / $672.52 / $840.65
| Professional | | $504.39 | $672.52 | $840.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.29 / $924.72 / $2,906.13
| Facility | | $742.29 | $924.72 | $2,906.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.26 / $346.34 / $790.21
| Professional | | $336.26 | $346.34 | $790.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.41 / $1,235.57 / $2,450.69
| Facility | | $546.41 | $1,235.57 | $2,450.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.12 / $966.01 / $1,431.78
| Professional | | $466.12 | $966.01 | $1,431.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.31 / $420.33 / $885.92
| Professional | | $295.31 | $420.33 | $885.92 |