- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $630.96 / $3,019.95
| Facility | | $575.44 | $630.96 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $602.56 / $741.31
| Professional | | $512.86 | $602.56 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $724.44
| Professional | | $501.19 | $660.69 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,258.93 / $2,041.74
| Professional | | $562.34 | $1,258.93 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $1,318.26
| Facility | | $588.84 | $794.33 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,071.52 / $3,801.89
| Professional | | $645.65 | $1,071.52 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $977.24 / $1,445.44
| Professional | | $602.56 | $977.24 | $1,445.44 |