- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.43 / $456.22 / $2,773.82
| Facility | | $409.43 | $456.22 | $2,773.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.22 / $456.22 / $467.92
| Professional | | $456.22 | $456.22 | $467.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $799.85
| Professional | | $584.90 | $584.90 | $799.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,063.01 / $1,440.92 / $3,335.03
| Facility | | $1,063.01 | $1,440.92 | $3,335.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.22 / $584.90 / $736.97
| Facility | | $456.22 | $584.90 | $736.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $333.62 / $532.62
| Professional | | $245.66 | $333.62 | $532.62 |