- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,071.52 / $2,041.74
| Facility | | $457.09 | $1,071.52 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $478.63 / $707.95
| Professional | | $354.81 | $478.63 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,202.26
| Facility | | $891.25 | $891.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $478.63 / $645.65
| Professional | | $426.58 | $478.63 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $794.33
| Professional | | $338.84 | $562.34 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,288.25 / $2,884.03
| Facility | | $588.84 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $794.33
| Professional | | $354.81 | $457.09 | $794.33 |