- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,380.38 / $3,630.78
| Facility | | $660.69 | $1,380.38 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $912.01
| Professional | | $524.81 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,348.96 / $3,801.89
| Facility | | $575.44 | $1,348.96 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $245.47 / $977.24
| Professional | | $239.88 | $245.47 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,258.93 / $3,235.94
| Facility | | $512.86 | $1,258.93 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,148.15 / $2,187.76
| Professional | | $912.01 | $1,148.15 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $954.99
| Facility | | $478.63 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $954.99
| Professional | | $331.13 | $478.63 | $954.99 |