- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,071.52 / $2,454.71
| Facility | | $426.58 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $257.04 / $380.19
| Professional | | $208.93 | $257.04 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,513.56
| Facility | | $1,096.48 | $1,096.48 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $323.59
| Professional | | $239.88 | $239.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $676.08
| Facility | | $512.86 | $562.34 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $416.87
| Professional | | $218.78 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,288.25 / $3,388.44
| Facility | | $562.34 | $1,288.25 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $281.84 / $436.52
| Professional | | $208.93 | $281.84 | $436.52 |