- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.38 / $1,220.72 / $2,061.31
| Facility | | $744.38 | $1,220.72 | $2,061.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.91 / $727.10 / $799.41
| Professional | | $574.91 | $727.10 | $799.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.52 / $730.48 / $2,060.63
| Facility | | $654.52 | $730.48 | $2,060.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.36 / $180.36 / $676.37
| Professional | | $180.36 | $180.36 | $676.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.63 / $1,134.27 / $1,978.38
| Facility | | $603.63 | $1,134.27 | $1,978.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.04 / $823.90 / $987.13
| Professional | | $785.04 | $823.90 | $987.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.56 / $1,014.56 / $1,014.56
| Facility | | $1,014.56 | $1,014.56 | $1,014.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.08 / $405.82 / $777.83
| Professional | | $284.08 | $405.82 | $777.83 |