- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,071.52 / $2,041.74
| Facility | | $575.44 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,096.48
| Professional | | $478.63 | $691.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $3,019.95
| Facility | | $2,187.76 | $2,187.76 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $691.83 / $977.24
| Professional | | $524.81 | $691.83 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Facility | | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,230.27
| Professional | | $478.63 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,412.54 / $4,677.35
| Facility | | $588.84 | $1,412.54 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $1,096.48
| Professional | | $446.68 | $660.69 | $1,096.48 |