- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,174.90 / $2,951.21
| Facility | | $562.34 | $1,174.90 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $588.84 / $954.99
| Professional | | $457.09 | $588.84 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $3,090.30
| Facility | | $602.56 | $870.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $1,258.93
| Professional | | $281.84 | $489.78 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,288.25 / $2,951.21
| Facility | | $436.52 | $1,288.25 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $831.76 / $1,621.81
| Professional | | $346.74 | $831.76 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $676.08 / $812.83
| Facility | | $407.38 | $676.08 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $851.14
| Professional | | $281.84 | $407.38 | $851.14 |