- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,258.93 / $2,398.83
| Facility | | $354.81 | $1,258.93 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $537.03
| Professional | | $354.81 | $436.52 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,311.31
| Facility | | $3,162.28 | $3,162.28 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $537.03 / $724.44
| Professional | | $501.19 | $537.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,288.25 / $2,884.03
| Facility | | $331.13 | $1,288.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $676.08
| Professional | | $234.42 | $234.42 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $870.96
| Facility | | $354.81 | $457.09 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $512.86 / $616.60
| Facility | | $457.09 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $295.12 / $512.86
| Professional | | $213.80 | $295.12 | $512.86 |