- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.31 / $355.73 / $1,296.65
| Facility | | $261.31 | $355.73 | $1,296.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.90 / $293.36 / $320.48
| Professional | | $164.90 | $293.36 | $320.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.45 / $617.29 / $913.24
| Facility | | $318.45 | $617.29 | $913.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $274.83 / $274.83
| Facility | | $274.83 | $274.83 | $274.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.52 / $473.26 / $1,941.02
| Facility | | $287.52 | $473.26 | $1,941.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $140.54 / $320.48
| Professional | | $103.54 | $140.54 | $320.48 |