- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,445.44 / $2,951.21
| Facility | | $426.58 | $1,445.44 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $524.81
| Professional | | $251.19 | $426.58 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,380.38 / $2,187.76
| Facility | | $1,148.15 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $676.08 / $1,174.90
| Facility | | $354.81 | $676.08 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $1,288.25
| Professional | | $691.83 | $691.83 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $707.95
| Facility | | $302.00 | $426.58 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $851.14
| Facility | | $269.15 | $269.15 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |