- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.20 / $563.85 / $2,055.26
| Facility | | $414.20 | $563.85 | $2,055.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.06 / $433.73 / $507.98
| Professional | | $293.06 | $433.73 | $507.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.10 / $763.10 / $1,202.42
| Facility | | $423.10 | $763.10 | $1,202.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.99 / $2,759.55 / $2,966.46
| Facility | | $253.99 | $2,759.55 | $2,966.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.93 / $448.93 / $561.16
| Professional | | $448.93 | $448.93 | $561.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.30 / $195.38 / $586.13
| Professional | | $156.30 | $195.38 | $586.13 |