- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,023.29 / $2,570.40
| Facility | | $478.63 | $1,023.29 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $537.03 / $812.83
| Professional | | $199.53 | $537.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $2,818.38
| Facility | | $501.19 | $870.96 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $141.25 / $691.83
| Professional | | $112.20 | $141.25 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,258.93 / $2,884.03
| Facility | | $281.84 | $1,258.93 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $912.01 / $1,737.80
| Professional | | $346.74 | $912.01 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $676.08 / $812.83
| Facility | | $245.47 | $676.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $169.82 / $478.63
| Professional | | $117.49 | $169.82 | $478.63 |