- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $812.83 / $1,412.54
| Facility | | $676.08 | $812.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $812.83 / $1,348.96
| Professional | | $676.08 | $812.83 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $891.25 / $3,162.28
| Facility | | $645.65 | $891.25 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $977.24 / $1,862.09
| Professional | | $851.14 | $977.24 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $6,606.93
| Facility | | $1,122.02 | $1,122.02 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $2,290.87
| Professional | | $812.83 | $812.83 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $1,949.84
| Facility | | $707.95 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $1,202.26
| Professional | | $588.84 | $794.33 | $1,202.26 |