- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.35 / $988.55 / $2,002.04
| Facility | | $534.35 | $988.55 | $2,002.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.35 / $555.73 / $604.17
| Professional | | $534.35 | $555.73 | $604.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.48 / $463.11 / $1,139.95
| Professional | | $370.48 | $463.11 | $1,139.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.11 / $1,534.70 / $2,037.68
| Facility | | $477.11 | $1,534.70 | $2,037.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.98 / $868.13 / $1,085.16
| Professional | | $818.98 | $868.13 | $1,085.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.70 / $3,384.23 / $3,384.23
| Facility | | $1,239.70 | $3,384.23 | $3,384.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.24 / $427.48 / $712.47
| Professional | | $299.24 | $427.48 | $712.47 |