- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,905.46 / $2,398.83
| Facility | | $446.68 | $1,905.46 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $524.81
| Professional | | $316.23 | $398.11 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $309.03 / $524.81
| Professional | | $251.19 | $309.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $912.01 / $1,096.48
| Facility | | $316.23 | $912.01 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,071.52
| Professional | | $831.76 | $831.76 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $912.01 / $912.01
| Facility | | $380.19 | $912.01 | $912.01 |