- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.70 / $530.05 / $3,222.76
| Facility | | $475.70 | $530.05 | $3,222.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.74 / $530.05 / $591.23
| Professional | | $407.74 | $530.05 | $591.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.17 / $713.56 / $4,183.72
| Facility | | $693.17 | $713.56 | $4,183.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.57 / $679.57 / $929.31
| Professional | | $679.57 | $679.57 | $929.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.05 / $1,970.07 / $3,874.77
| Facility | | $1,235.05 | $1,970.07 | $3,874.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.93 / $431.85 / $1,549.65
| Professional | | $309.93 | $431.85 | $1,549.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.05 / $679.57 / $842.67
| Facility | | $530.05 | $679.57 | $842.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.57 / $679.57 / $679.57
| Professional | | $679.57 | $679.57 | $679.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.76 / $373.76 / $538.22
| Professional | | $373.76 | $373.76 | $538.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.42 / $407.74 / $679.57
| Professional | | $285.42 | $407.74 | $679.57 |