- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.92 / $983.50 / $2,026.40
| Facility | | $630.92 | $983.50 | $2,026.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.59 / $608.66 / $668.04
| Professional | | $519.59 | $608.66 | $668.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $749.26 / $1,089.28 / $3,154.64
| Facility | | $749.26 | $1,089.28 | $3,154.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.32 / $699.20 / $1,066.70
| Professional | | $594.32 | $699.20 | $1,066.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.78 / $1,248.42 / $2,308.17
| Facility | | $618.78 | $1,248.42 | $2,308.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.72 / $904.47 / $1,130.58
| Professional | | $890.72 | $904.47 | $1,130.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.27 / $742.27 / $742.27
| Facility | | $742.27 | $742.27 | $742.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $445.36 / $853.61
| Professional | | $311.75 | $445.36 | $853.61 |