- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,096.48 / $2,884.03
| Facility | | $524.81 | $1,096.48 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $776.25
| Professional | | $416.87 | $512.86 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $281.84 / $1,318.26
| Facility | | $208.93 | $281.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $223.87 / $691.83
| Professional | | $208.93 | $223.87 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,047.13 / $2,818.38
| Facility | | $416.87 | $1,047.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $1,548.82
| Professional | | $602.56 | $912.01 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $645.65 / $776.25
| Facility | | $288.40 | $645.65 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $380.19 / $741.31
| Professional | | $269.15 | $380.19 | $741.31 |