- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $933.25 / $2,630.27
| Facility | | $446.68 | $933.25 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $457.09 / $588.84
| Professional | | $389.05 | $457.09 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $1,148.15 / $1,513.56
| Facility | | $72.44 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $588.84 / $1,023.29
| Professional | | $208.93 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $812.83 / $3,467.37
| Facility | | $371.54 | $812.83 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $794.33 / $1,778.28
| Professional | | $446.68 | $794.33 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $891.25 / $1,548.82
| Facility | | $426.58 | $891.25 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $912.01
| Professional | | $288.40 | $501.19 | $912.01 |