- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.44 / $1,568.50 / $2,423.65
| Facility | | $792.44 | $1,568.50 | $2,423.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $660.37 / $812.18
| Professional | | $455.43 | $660.37 | $812.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.81 / $948.81 / $948.81
| Professional | | $948.81 | $948.81 | $948.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.71 / $706.29 / $3,262.47
| Facility | | $398.71 | $706.29 | $3,262.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.60 / $960.96 / $1,163.00
| Professional | | $500.60 | $960.96 | $1,163.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.43 / $455.43 / $1,320.75
| Facility | | $455.43 | $455.43 | $1,320.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $481.40 / $1,548.46
| Professional | | $318.80 | $481.40 | $1,548.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.26 / $759.05 / $1,138.58
| Facility | | $273.26 | $759.05 | $1,138.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $455.43 / $1,363.96
| Professional | | $341.57 | $455.43 | $1,363.96 |