- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $223.87 / $407.38
| Professional | | $125.89 | $223.87 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $416.87
| Facility | | $257.04 | $309.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $204.17 / $354.81
| Professional | | $154.88 | $204.17 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $489.78
| Professional | | $134.90 | $223.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $204.17 / $363.08
| Professional | | $114.82 | $204.17 | $363.08 |