- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.38 / $754.77 / $1,813.11
| Facility | | $522.38 | $754.77 | $1,813.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.08 / $522.38 / $556.14
| Professional | | $421.08 | $522.38 | $556.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.68 / $1,165.91 / $1,966.36
| Facility | | $258.68 | $1,165.91 | $1,966.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.18 / $3,522.25 / $5,182.74
| Professional | | $405.18 | $3,522.25 | $5,182.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.41 / $2,202.61 / $4,559.38
| Facility | | $516.41 | $2,202.61 | $4,559.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.66 / $1,447.56 / $1,962.39
| Professional | | $913.66 | $1,447.56 | $1,962.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.47 / $490.52 / $1,394.25
| Professional | | $365.47 | $490.52 | $1,394.25 |