- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $794.33 / $1,621.81
| Facility | | $316.23 | $794.33 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $478.63
| Professional | | $251.19 | $316.23 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,090.30 / $5,011.87
| Facility | | $1,949.84 | $3,090.30 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $512.86
| Facility | | $223.87 | $331.13 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $354.81 / $575.44
| Facility | | $104.71 | $354.81 | $575.44 |