- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.74 / $804.14 / $2,235.16
| Facility | | $798.74 | $804.14 | $2,235.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.21 / $151.81 / $238.02
| Professional | | $138.21 | $151.81 | $238.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.03 / $842.80 / $1,012.37
| Professional | | $576.03 | $842.80 | $1,012.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.05 / $450.37 / $577.69
| Professional | | $315.05 | $450.37 | $577.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.91 / $302.54 / $511.40
| Professional | | $244.91 | $302.54 | $511.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $798.74 / $1,781.04 / $4,280.64
| Facility | | $798.74 | $1,781.04 | $4,280.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.21 / $145.06 / $238.02
| Professional | | $138.21 | $145.06 | $238.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.04 / $288.13 / $776.98
| Professional | | $191.04 | $288.13 | $776.98 |