- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $2,454.71
| Facility | | $436.52 | $549.54 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $467.74 / $691.83
| Professional | | $436.52 | $467.74 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $794.33 / $794.33
| Professional | | $416.87 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,380.38 / $2,238.72
| Facility | | $380.19 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $446.68 / $977.24
| Professional | | $263.03 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $398.11 / $575.44
| Facility | | $208.93 | $398.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $630.96
| Professional | | $245.47 | $380.19 | $630.96 |