- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.56 / $1,113.89 / $2,101.67
| Facility | | $700.56 | $1,113.89 | $2,101.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.39 / $525.41 / $595.48
| Professional | | $490.39 | $525.41 | $595.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.94 / $1,028.07 / $2,732.18
| Facility | | $387.94 | $1,028.07 | $2,732.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $823.02
| Professional | | $335.33 | $335.33 | $823.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,523.87 / $2,253.48 / $3,634.79
| Facility | | $1,523.87 | $2,253.48 | $3,634.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $853.23 / $853.23 / $1,022.27
| Professional | | $853.23 | $853.23 | $1,022.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.50 / $630.50 / $630.50
| Facility | | $630.50 | $630.50 | $630.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.24 / $420.34 / $805.64
| Professional | | $294.24 | $420.34 | $805.64 |