- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,548.82 / $3,235.94
| Facility | | $380.19 | $1,548.82 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $524.81
| Professional | | $316.23 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $933.25 / $1,513.56
| Facility | | $562.34 | $933.25 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $524.81 / $933.25
| Professional | | $251.19 | $524.81 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $912.01 / $2,137.96
| Facility | | $354.81 | $912.01 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Professional | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $588.84 / $1,122.02
| Facility | | $281.84 | $588.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $1,122.02 / $1,949.84
| Professional | | $50.12 | $1,122.02 | $1,949.84 |