- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.95 / $1,348.85 / $2,357.89
| Facility | | $486.95 | $1,348.85 | $2,357.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.55 / $518.99 / $608.69
| Professional | | $480.55 | $518.99 | $608.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.17 / $1,909.38 / $2,934.54
| Facility | | $852.17 | $1,909.38 | $2,934.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.10 / $269.10 / $470.29
| Professional | | $269.10 | $269.10 | $470.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.49 / $562.23 / $1,649.22
| Facility | | $366.49 | $562.23 | $1,649.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.63 / $768.88 / $835.78
| Professional | | $668.63 | $768.88 | $835.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.95 / $499.77 / $818.08
| Facility | | $486.95 | $499.77 | $818.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.29 / $832.95 / $1,185.34
| Professional | | $429.29 | $832.95 | $1,185.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.11 / $269.11 / $493.36
| Professional | | $269.11 | $269.11 | $493.36 |