- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $2,187.76
| Facility | | $436.52 | $891.25 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $776.25
| Professional | | $323.59 | $426.58 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $2,398.83
| Facility | | $446.68 | $676.08 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $812.83
| Professional | | $208.93 | $316.23 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $977.24 / $2,187.76
| Facility | | $281.84 | $977.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $645.65 / $1,288.25
| Professional | | $263.03 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $630.96
| Facility | | $316.23 | $524.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $630.96
| Professional | | $223.87 | $316.23 | $630.96 |