- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $416.87 / $1,513.56
| Facility | | $229.09 | $416.87 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $269.15 / $562.34
| Professional | | $208.93 | $269.15 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $741.31 / $3,981.07
| Facility | | $281.84 | $741.31 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $630.96
| Professional | | $218.78 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $912.01 / $4,073.80
| Facility | | $316.23 | $912.01 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $398.11 / $741.31
| Professional | | $229.09 | $398.11 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,949.84 / $3,981.07
| Facility | | $954.99 | $1,949.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $630.96
| Professional | | $218.78 | $316.23 | $630.96 |