- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.54 / $727.40 / $2,587.82
| Facility | | $559.54 | $727.40 | $2,587.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.72 / $638.72 / $686.23
| Professional | | $316.72 | $638.72 | $686.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.58 / $1,030.88 / $1,650.96
| Facility | | $571.58 | $1,030.88 | $1,650.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.08 / $580.66 / $580.66
| Professional | | $475.08 | $580.66 | $580.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.87 / $527.87 / $527.87
| Facility | | $527.87 | $527.87 | $527.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.23 / $975.53 / $2,453.54
| Facility | | $552.23 | $975.53 | $2,453.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.10 / $546.85 / $1,086.02
| Professional | | $230.10 | $546.85 | $1,086.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.15 / $284.22 / $686.23
| Professional | | $211.15 | $284.22 | $686.23 |