- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.65 / $636.09 / $1,628.38
| Facility | | $381.65 | $636.09 | $1,628.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.65 / $402.01 / $559.76
| Professional | | $381.65 | $402.01 | $559.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.45 / $610.64 / $1,002.47
| Professional | | $266.45 | $610.64 | $1,002.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.66 / $1,229.16 / $1,596.07
| Facility | | $295.66 | $1,229.16 | $1,596.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.81 / $338.55 / $866.50
| Professional | | $227.81 | $338.55 | $866.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.43 / $2,417.13 / $2,417.13
| Facility | | $885.43 | $2,417.13 | $2,417.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,544.35 / $2,544.35 / $3,816.53
| Professional | | $2,544.35 | $2,544.35 | $3,816.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.73 / $305.32 / $508.87
| Professional | | $213.73 | $305.32 | $508.87 |