- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.46 / $1,116.46 / $1,137.58
| Facility | | $1,116.46 | $1,116.46 | $1,137.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.48 / $990.55 / $1,202.84
| Professional | | $755.48 | $990.55 | $1,202.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.51 / $501.65 / $578.55
| Facility | | $187.51 | $501.65 | $578.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.83 / $974.83 / $1,162.16
| Professional | | $974.83 | $974.83 | $1,162.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.04 / $860.04 / $860.04
| Facility | | $860.04 | $860.04 | $860.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.03 / $860.04 / $1,850.26
| Professional | | $731.03 | $860.04 | $1,850.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.77 / $755.38 / $1,144.91
| Professional | | $527.77 | $755.38 | $1,144.91 |