- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $2,570.40 / $6,760.83
| Facility | | $331.13 | $2,570.40 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $977.24
| Professional | | $257.04 | $346.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $436.52 / $489.78
| Professional | | $346.74 | $436.52 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $416.87 / $575.44
| Professional | | $338.84 | $416.87 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $575.44 / $2,344.23
| Facility | | $331.13 | $575.44 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $616.60 / $2,398.83
| Professional | | $371.54 | $616.60 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $870.96
| Professional | | $436.52 | $537.03 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,548.13
| Facility | | $1,148.15 | $1,621.81 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,122.02
| Professional | | $371.54 | $575.44 | $1,122.02 |