- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $649.30 / $1,108.45 / $2,336.72
| Facility | | $649.30 | $1,108.45 | $2,336.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.13 / $649.30 / $801.62
| Professional | | $561.13 | $649.30 | $801.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.83 / $870.50 / $2,773.61
| Facility | | $707.83 | $870.50 | $2,773.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.61 / $320.64 / $588.38
| Professional | | $259.61 | $320.64 | $588.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.26 / $1,037.34 / $2,328.93
| Facility | | $484.26 | $1,037.34 | $2,328.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.11 / $721.35 / $1,151.24
| Professional | | $175.11 | $721.35 | $1,151.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.13 / $336.68 / $801.62
| Professional | | $202.13 | $336.68 | $801.62 |