- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,445.44 / $2,238.72
| Facility | | $870.96 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $1,096.48
| Professional | | $512.86 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $4,168.69 / $5,623.41
| Facility | | $3,548.13 | $4,168.69 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $776.25 / $912.01
| Professional | | $537.03 | $776.25 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $676.08 / $912.01
| Professional | | $416.87 | $676.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,174.90 / $2,511.89
| Facility | | $407.38 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $870.96
| Professional | | $416.87 | $588.84 | $870.96 |