- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $1,905.46
| Facility | | $1,047.13 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $234.42 / $602.56
| Professional | | $107.15 | $234.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $234.42 / $501.19
| Professional | | $104.71 | $234.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $239.88 / $602.56
| Professional | | $141.25 | $239.88 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $371.54 / $602.56
| Professional | | $117.49 | $371.54 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,288.25 / $1,905.46
| Facility | | $1,047.13 | $1,288.25 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $346.74 / $758.58
| Professional | | $107.15 | $346.74 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $295.12 / $676.08
| Professional | | $134.90 | $295.12 | $676.08 |