- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $316.23 / $524.81
| Professional | | $213.80 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $2,398.83
| Facility | | $1,479.11 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $354.81
| Professional | | $199.53 | $275.42 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $831.76
| Professional | | $186.21 | $281.84 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,148.15 / $2,511.89
| Facility | | $398.11 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $331.13
| Professional | | $177.83 | $245.47 | $331.13 |