- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,071.52 / $1,548.82
| Facility | | $831.76 | $1,071.52 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,096.48 / $1,445.44
| Professional | | $776.25 | $1,096.48 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $147.91 / $676.08
| Facility | | $114.82 | $147.91 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $1,949.84
| Professional | | $912.01 | $1,230.27 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $6,456.54
| Facility | | $575.44 | $1,445.44 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,202.26 / $2,630.27
| Professional | | $338.84 | $1,202.26 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $660.69 / $1,174.90
| Facility | | $87.10 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $891.25 / $1,548.82
| Professional | | $602.56 | $891.25 | $1,548.82 |