- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.87 / $737.66 / $2,688.82
| Facility | | $541.87 | $737.66 | $2,688.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.40 / $567.42 / $664.56
| Professional | | $383.40 | $567.42 | $664.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.53 / $998.32 / $1,573.06
| Facility | | $553.53 | $998.32 | $1,573.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.28 / $411.69 / $3,882.38
| Facility | | $332.28 | $411.69 | $3,882.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.94 / $587.29 / $734.11
| Professional | | $270.94 | $587.29 | $734.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.72 / $306.72 / $306.72
| Facility | | $306.72 | $306.72 | $306.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.48 / $255.60 / $766.80
| Professional | | $204.48 | $255.60 | $766.80 |