- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,412.54 / $2,884.03
| Facility | | $758.58 | $1,412.54 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,288.25
| Professional | | $512.86 | $645.65 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,288.25 / $1,778.28
| Facility | | $630.96 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $741.31 / $1,479.11
| Professional | | $371.54 | $741.31 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $1,122.02
| Facility | | $630.96 | $776.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $3,890.45
| Professional | | $331.13 | $467.74 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $776.25 / $933.25
| Facility | | $331.13 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $467.74 / $1,023.29
| Professional | | $331.13 | $467.74 | $1,023.29 |