- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $794.33 / $2,041.74
| Facility | | $446.68 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $691.83
| Professional | | $338.84 | $489.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $3,981.07
| Facility | | $2,884.03 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $758.58
| Professional | | $380.19 | $501.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $512.86 / $1,737.80
| Facility | | $363.08 | $512.86 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $537.03 / $812.83
| Professional | | $346.74 | $537.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $1,288.25 / $5,248.07
| Facility | | $537.03 | $1,288.25 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $794.33
| Professional | | $331.13 | $501.19 | $794.33 |