- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.39 / $1,369.55 / $1,848.89
| Facility | | $748.39 | $1,369.55 | $1,848.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.29 / $561.29 / $561.29
| Professional | | $561.29 | $561.29 | $561.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.91 / $1,010.33 / $1,010.33
| Facility | | $972.91 | $1,010.33 | $1,010.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.41 / $1,156.41 / $1,156.41
| Professional | | $1,156.41 | $1,156.41 | $1,156.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.45 / $486.45 / $510.77
| Facility | | $486.45 | $486.45 | $510.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $42.50
| Professional | | $17.00 | $20.00 | $42.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.32 / $449.03 / $1,272.26
| Professional | | $314.32 | $449.03 | $1,272.26 |