- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.84 / $806.11 / $4,661.31
| Facility | | $346.84 | $806.11 | $4,661.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.43 / $437.25 / $685.15
| Professional | | $306.43 | $437.25 | $685.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.65 / $870.53 / $1,187.86
| Professional | | $672.65 | $870.53 | $1,187.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.87 / $887.69 / $1,468.39
| Professional | | $500.87 | $887.69 | $1,468.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.84 / $574.40 / $986.27
| Facility | | $346.84 | $574.40 | $986.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.08 / $927.02 / $2,553.36
| Professional | | $516.08 | $927.02 | $2,553.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,552.76 / $5,552.76 / $5,552.76
| Facility | | $5,552.76 | $5,552.76 | $5,552.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.08 / $927.02 / $1,315.86
| Professional | | $516.08 | $927.02 | $1,315.86 |