- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $2,089.30
| Facility | | $436.52 | $588.84 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $512.86
| Professional | | $245.47 | $346.74 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $794.33 / $1,288.25
| Facility | | $446.68 | $794.33 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $3,090.30
| Facility | | $263.03 | $457.09 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $407.38 / $407.38
| Facility | | $169.82 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $204.17 / $575.44
| Professional | | $169.82 | $204.17 | $575.44 |