- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $870.96 / $2,290.87
| Facility | | $426.58 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $549.54
| Professional | | $331.13 | $407.38 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $851.14 / $2,454.71
| Facility | | $331.13 | $851.14 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $104.71 / $512.86
| Professional | | $69.18 | $104.71 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,096.48 / $2,238.72
| Facility | | $331.13 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $741.31 / $1,230.27
| Professional | | $588.84 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $512.86 / $616.60
| Facility | | $229.09 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $588.84
| Professional | | $213.80 | $309.03 | $588.84 |