- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $794.33 / $2,041.74
| Facility | | $575.44 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $741.31
| Professional | | $446.68 | $537.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $288.40
| Facility | | $208.93 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $562.34 / $741.31
| Professional | | $512.86 | $562.34 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $741.31 / $870.96
| Professional | | $446.68 | $741.31 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $346.74 / $776.25
| Facility | | $128.82 | $346.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $891.25
| Professional | | $446.68 | $588.84 | $891.25 |