- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,513.56 / $2,884.03
| Facility | | $426.58 | $1,513.56 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $489.78 / $588.84
| Professional | | $426.58 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $645.65 / $851.14
| Professional | | $602.56 | $645.65 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,513.56 / $3,467.37
| Facility | | $398.11 | $1,513.56 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $501.19 / $776.25
| Facility | | $363.08 | $501.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $602.56 / $724.44
| Facility | | $549.54 | $602.56 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $363.08 / $602.56
| Professional | | $257.04 | $363.08 | $602.56 |