- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $616.60 / $1,288.25
| Facility | | $426.58 | $616.60 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $416.87
| Professional | | $234.42 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $1,148.15
| Facility | | $524.81 | $707.95 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $524.81
| Professional | | $114.82 | $173.78 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $575.44 / $1,548.82
| Facility | | $275.42 | $575.44 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $933.25
| Professional | | $575.44 | $794.33 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $257.04 / $741.31
| Professional | | $204.17 | $257.04 | $741.31 |