- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.60 / $3,817.86 / $5,005.47
| Facility | | $728.60 | $3,817.86 | $5,005.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.82 / $492.56 / $728.60
| Professional | | $428.82 | $492.56 | $728.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.31 / $509.42 / $1,596.66
| Facility | | $495.31 | $509.42 | $1,596.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.26 / $665.76 / $832.20
| Professional | | $341.26 | $665.76 | $832.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.48 / $666.40 / $2,607.55
| Facility | | $579.48 | $666.40 | $2,607.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.57 / $472.37 / $667.93
| Professional | | $443.57 | $472.37 | $667.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.38 / $342.54 / $347.69
| Professional | | $243.38 | $342.54 | $347.69 |