- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.17 / $888.38 / $2,404.77
| Facility | | $549.17 | $888.38 | $2,404.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.80 / $500.24 / $512.29
| Professional | | $400.80 | $500.24 | $512.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.36 / $1,577.43 / $2,498.87
| Facility | | $415.36 | $1,577.43 | $2,498.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.46 / $575.22 / $2,786.20
| Professional | | $395.46 | $575.22 | $2,786.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.60 / $979.40 / $1,762.92
| Facility | | $402.60 | $979.40 | $1,762.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.81 / $602.70 / $1,109.77
| Facility | | $403.81 | $602.70 | $1,109.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $253.13 / $3,001.45
| Professional | | $253.13 | $253.13 | $3,001.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $253.13 / $361.62
| Professional | | $253.13 | $253.13 | $361.62 |