- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $2,884.03
| Facility | | $575.44 | $891.25 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $794.33
| Professional | | $575.44 | $575.44 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,584.89 / $6,025.60
| Facility | | $1,047.13 | $1,584.89 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $602.56 / $1,479.11
| Professional | | $269.15 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $758.58 / $2,344.23
| Facility | | $281.84 | $758.58 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $630.96 / $1,380.38
| Professional | | $363.08 | $630.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $724.44 / $1,621.81
| Facility | | $478.63 | $724.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $630.96 / $1,148.15
| Professional | | $489.78 | $630.96 | $1,148.15 |