- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.54 / $761.72 / $2,776.51
| Facility | | $559.54 | $761.72 | $2,776.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.72 / $628.16 / $686.23
| Professional | | $316.72 | $628.16 | $686.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.58 / $1,030.88 / $1,624.36
| Facility | | $571.58 | $1,030.88 | $1,624.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.87 / $527.87 / $527.87
| Facility | | $527.87 | $527.87 | $527.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.12 / $425.13 / $4,008.45
| Facility | | $343.12 | $425.13 | $4,008.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.71 / $300.94 / $659.84
| Professional | | $221.71 | $300.94 | $659.84 |