- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.51 / $687.05 / $1,738.44
| Facility | | $550.51 | $687.05 | $1,738.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.75 / $522.75 / $552.12
| Professional | | $522.75 | $522.75 | $552.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.48 / $850.39 / $1,615.91
| Facility | | $579.48 | $850.39 | $1,615.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.17 / $347.68 / $922.95
| Professional | | $286.17 | $347.68 | $922.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.86 / $738.80 / $2,114.83
| Facility | | $380.86 | $738.80 | $2,114.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.53 / $665.76 / $934.89
| Professional | | $413.53 | $665.76 | $934.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.56 / $463.58 / $852.60
| Professional | | $266.56 | $463.58 | $852.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.38 / $404.88 / $1,016.93
| Professional | | $243.38 | $404.88 | $1,016.93 |