- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,584.89 / $3,890.45
| Facility | | $776.25 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $851.14 / $1,230.27
| Professional | | $660.69 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $4,265.80
| Facility | | $831.76 | $1,202.26 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $2,691.53
| Professional | | $371.54 | $489.78 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,737.80 / $3,981.07
| Facility | | $602.56 | $1,737.80 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,122.02 / $2,238.72
| Professional | | $467.74 | $1,122.02 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $933.25 / $1,122.02
| Facility | | $416.87 | $933.25 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $1,071.52
| Professional | | $389.05 | $562.34 | $1,071.52 |