- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,096.48 / $2,884.03
| Facility | | $537.03 | $1,096.48 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $724.44
| Professional | | $416.87 | $512.86 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,071.52 / $3,162.28
| Facility | | $537.03 | $1,071.52 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $269.15 / $831.76
| Professional | | $257.04 | $269.15 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,047.13 / $2,754.23
| Facility | | $416.87 | $1,047.13 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $933.25 / $1,737.80
| Professional | | $741.31 | $933.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $630.96 / $758.58
| Facility | | $380.19 | $630.96 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $758.58
| Professional | | $269.15 | $380.19 | $758.58 |