- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $1,318.26
| Facility | | $363.08 | $524.81 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $512.86 / $933.25
| Professional | | $389.05 | $512.86 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $1,949.84
| Facility | | $398.11 | $537.03 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $537.03 / $1,096.48
| Professional | | $501.19 | $537.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $3,311.31
| Facility | | $562.34 | $562.34 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $1,258.93
| Professional | | $416.87 | $416.87 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $1,202.26
| Facility | | $338.84 | $575.44 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $489.78 / $741.31
| Professional | | $338.84 | $489.78 | $741.31 |