- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.90 / $1,533.83 / $2,370.07
| Facility | | $816.90 | $1,533.83 | $2,370.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.82 / $645.77 / $742.27
| Professional | | $593.82 | $645.77 | $742.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $927.84 / $927.84 / $927.84
| Professional | | $927.84 | $927.84 | $927.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.17 / $1,215.84 / $1,682.78
| Facility | | $656.17 | $1,215.84 | $1,682.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.66 / $751.55 / $998.59
| Facility | | $608.66 | $751.55 | $998.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $445.36 / $3,696.50
| Professional | | $311.75 | $445.36 | $3,696.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $445.36 / $1,113.41
| Professional | | $311.75 | $445.36 | $1,113.41 |