- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $1,737.80
| Facility | | $436.52 | $575.44 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $446.68 / $575.44
| Professional | | $389.05 | $446.68 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $1,548.82
| Facility | | $380.19 | $380.19 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $512.86 / $831.76
| Professional | | $234.42 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $2,754.23
| Facility | | $257.04 | $389.05 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $602.56
| Professional | | $245.47 | $245.47 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $575.44 / $691.83
| Facility | | $208.93 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $346.74
| Professional | | $245.47 | $245.47 | $346.74 |