- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.55 / $920.83 / $1,894.20
| Facility | | $634.55 | $920.83 | $1,894.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.38 / $606.08 / $795.36
| Professional | | $507.38 | $606.08 | $795.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.65 / $781.29 / $2,340.69
| Facility | | $654.65 | $781.29 | $2,340.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.81 / $422.81 / $789.79
| Professional | | $282.81 | $422.81 | $789.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.10 / $1,169.68 / $2,121.58
| Facility | | $550.10 | $1,169.68 | $2,121.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.88 / $723.24 / $1,383.09
| Professional | | $373.88 | $723.24 | $1,383.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.11 / $1,163.11 / $1,437.56
| Facility | | $1,163.11 | $1,163.11 | $1,437.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.13 / $405.90 / $893.45
| Professional | | $284.13 | $405.90 | $893.45 |