- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,862.09 / $3,548.13
| Facility | | $524.81 | $1,862.09 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $831.76
| Professional | | $524.81 | $602.56 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $794.33 / $1,047.13
| Professional | | $758.58 | $794.33 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,905.46 / $4,265.80
| Facility | | $489.78 | $1,905.46 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $676.08 / $1,380.38
| Facility | | $562.34 | $676.08 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $758.58 / $891.25
| Facility | | $676.08 | $758.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $758.58
| Professional | | $316.23 | $446.68 | $758.58 |