- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.19 / $1,049.58 / $2,144.31
| Facility | | $645.19 | $1,049.58 | $2,144.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $607.24 / $736.28
| Professional | | $455.43 | $607.24 | $736.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.53 / $834.96 / $2,626.31
| Facility | | $734.53 | $834.96 | $2,626.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.62 / $393.18 / $885.35
| Professional | | $303.62 | $393.18 | $885.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.57 / $1,195.85 / $2,231.59
| Facility | | $516.57 | $1,195.85 | $2,231.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.53 / $797.84 / $1,242.33
| Professional | | $379.53 | $797.84 | $1,242.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.41 / $740.57 / $910.86
| Facility | | $468.41 | $740.57 | $910.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $455.43 / $910.86
| Professional | | $318.80 | $455.43 | $910.86 |