- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.82 / $881.32 / $2,385.66
| Facility | | $544.82 | $881.32 | $2,385.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.61 / $448.43 / $508.22
| Professional | | $397.61 | $448.43 | $508.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.74 / $1,381.37 / $2,188.28
| Facility | | $363.74 | $1,381.37 | $2,188.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.31 / $503.73 / $2,439.92
| Professional | | $346.31 | $503.73 | $2,439.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.44 / $1,049.33 / $1,748.88
| Facility | | $436.44 | $1,049.33 | $1,748.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.60 / $597.91 / $1,080.41
| Facility | | $400.60 | $597.91 | $1,080.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.12 / $251.12 / $2,989.55
| Professional | | $251.12 | $251.12 | $2,989.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.12 / $251.12 / $358.75
| Professional | | $251.12 | $251.12 | $358.75 |