- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $245.47 / $489.78
| Professional | | $147.91 | $245.47 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,884.03 / $3,890.45
| Facility | | $2,398.83 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $323.59
| Professional | | $151.36 | $213.80 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $562.34
| Professional | | $147.91 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,174.90 / $2,511.89
| Facility | | $398.11 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $371.54
| Professional | | $128.82 | $208.93 | $371.54 |