- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,548.82 / $1,995.26
| Facility | | $1,348.96 | $1,548.82 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,096.48 / $1,548.82
| Professional | | $794.33 | $1,096.48 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $891.25
| Facility | | $549.54 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $870.96
| Professional | | $275.42 | $398.11 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,122.02 / $2,884.03
| Facility | | $1,047.13 | $1,122.02 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,202.26 / $1,348.96
| Facility | | $562.34 | $1,202.26 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $794.33
| Professional | | $562.34 | $562.34 | $794.33 |