- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,445.44 / $2,398.83
| Facility | | $660.69 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $831.76
| Professional | | $323.59 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $363.08
| Professional | | $275.42 | $354.81 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,398.83 / $3,235.94
| Facility | | $2,041.74 | $2,398.83 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $602.56 / $851.14
| Professional | | $389.05 | $602.56 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $478.63 / $1,047.13
| Professional | | $288.40 | $478.63 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,951.21 / $4,073.80
| Facility | | $812.83 | $2,951.21 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $407.38 / $660.69
| Professional | | $275.42 | $407.38 | $660.69 |