- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.60 / $726.40 / $2,647.80
| Facility | | $533.60 | $726.40 | $2,647.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.55 / $558.77 / $654.41
| Professional | | $377.55 | $558.77 | $654.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.96 / $928.12 / $1,358.88
| Facility | | $526.96 | $928.12 | $1,358.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $377.55 / $884.73
| Professional | | $3.93 | $377.55 | $884.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.88 / $965.93 / $3,556.55
| Facility | | $526.88 | $965.93 | $3,556.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.80 / $266.80 / $656.25
| Professional | | $266.80 | $266.80 | $656.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.36 / $251.70 / $755.10
| Professional | | $201.36 | $251.70 | $755.10 |