- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.11 / $376.69 / $452.03
| Facility | | $247.11 | $376.69 | $452.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.01 / $247.11 / $256.14
| Professional | | $226.01 | $247.11 | $256.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.35 / $406.82 / $497.23
| Facility | | $301.35 | $406.82 | $497.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.35 / $406.82 / $406.82
| Professional | | $301.35 | $406.82 | $406.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.85 / $745.61 / $1,601.02
| Facility | | $244.85 | $745.61 | $1,601.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.51 / $1,452.51 / $1,452.51
| Professional | | $1,452.51 | $1,452.51 | $1,452.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,013.02 / $2,013.02 / $2,112.36
| Facility | | $2,013.02 | $2,013.02 | $2,112.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $126.57
| Facility | | $126.57 | $126.57 | $126.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $150.68 / $436.96
| Professional | | $126.57 | $150.68 | $436.96 |