- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.28 / $602.70 / $1,375.42
| Facility | | $396.28 | $602.70 | $1,375.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.43 / $396.28 / $421.89
| Professional | | $319.43 | $396.28 | $421.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.55 / $397.82 / $1,267.96
| Facility | | $251.55 | $397.82 | $1,267.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.27 / $338.80 / $449.01
| Professional | | $261.27 | $338.80 | $449.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.76 / $1,938.55 / $3,459.96
| Facility | | $391.76 | $1,938.55 | $3,459.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.89 / $947.75 / $1,488.67
| Professional | | $421.89 | $947.75 | $1,488.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $361.62 / $1,057.68
| Professional | | $253.13 | $361.62 | $1,057.68 |