- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,380.38 / $1,548.82
| Facility | | $758.58 | $1,380.38 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $616.60 / $1,380.38
| Professional | | $562.34 | $616.60 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Professional | | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $512.86 / $630.96
| Facility | | $331.13 | $512.86 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $346.74 / $1,288.25
| Professional | | $323.59 | $346.74 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $912.01
| Facility | | $676.08 | $676.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $457.09 / $1,698.24
| Professional | | $316.23 | $457.09 | $1,698.24 |