- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.36 / $1,094.10 / $2,961.66
| Facility | | $676.36 | $1,094.10 | $2,961.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.61 / $616.08 / $630.92
| Professional | | $493.61 | $616.08 | $630.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.04 / $611.57 / $968.81
| Facility | | $161.04 | $611.57 | $968.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.77 / $521.85 / $2,527.69
| Professional | | $358.77 | $521.85 | $2,527.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.14 / $1,157.95 / $2,074.66
| Facility | | $431.14 | $1,157.95 | $2,074.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.32 / $742.27 / $1,324.22
| Facility | | $497.32 | $742.27 | $1,324.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $311.75 / $3,711.35
| Professional | | $311.75 | $311.75 | $3,711.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $311.75 / $445.36
| Professional | | $311.75 | $311.75 | $445.36 |