- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.36 / $884.47 / $3,146.61
| Facility | | $680.36 | $884.47 | $3,146.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.11 / $808.73 / $962.77
| Professional | | $385.11 | $808.73 | $962.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.92 / $1,206.29 / $2,063.31
| Facility | | $632.92 | $1,206.29 | $2,063.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.17 / $641.85 / $706.04
| Professional | | $316.17 | $641.85 | $706.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.85 / $641.85 / $641.85
| Facility | | $641.85 | $641.85 | $641.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.74 / $1,231.01 / $2,982.67
| Facility | | $671.74 | $1,231.01 | $2,982.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.94 / $547.41 / $1,320.47
| Professional | | $140.94 | $547.41 | $1,320.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.89 / $269.58 / $446.14
| Professional | | $120.89 | $269.58 | $446.14 |