- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,071.52 / $3,801.89
| Facility | | $794.33 | $1,071.52 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $630.96 / $933.25
| Professional | | $446.68 | $630.96 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,479.11 / $2,344.23
| Facility | | $812.83 | $1,479.11 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $5,623.41
| Facility | | $489.78 | $851.14 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $741.31 / $741.31
| Facility | | $316.23 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $1,047.13
| Professional | | $316.23 | $371.54 | $1,047.13 |