- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.54 / $2,785.32 / $3,651.75
| Facility | | $531.54 | $2,785.32 | $3,651.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.96 / $630.49 / $891.09
| Professional | | $442.96 | $630.49 | $891.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.54 / $739.02 / $2,316.27
| Facility | | $718.54 | $739.02 | $2,316.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.24 / $966.01 / $1,537.87
| Professional | | $797.24 | $966.01 | $1,537.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $966.75 / $3,404.63
| Facility | | $840.65 | $966.75 | $3,404.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.47 / $826.70 / $1,007.47
| Professional | | $643.47 | $826.70 | $1,007.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.06 / $353.07 / $504.39
| Professional | | $248.06 | $353.07 | $504.39 |