- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.45 / $534.08 / $1,345.87
| Facility | | $320.45 | $534.08 | $1,345.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.45 / $320.45 / $363.17
| Professional | | $320.45 | $320.45 | $363.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.18 / $563.98 / $841.70
| Professional | | $222.18 | $563.98 | $841.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.27 / $879.65 / $1,525.76
| Facility | | $244.27 | $879.65 | $1,525.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.26 / $427.26 / $2,059.39
| Professional | | $427.26 | $427.26 | $2,059.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.43 / $2,029.49 / $2,029.49
| Facility | | $743.43 | $2,029.49 | $2,029.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,136.30 / $2,136.30 / $3,204.45
| Professional | | $2,136.30 | $2,136.30 | $3,204.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.36 / $384.53 / $427.26
| Facility | | $256.36 | $384.53 | $427.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.45 / $256.36 / $427.26
| Professional | | $179.45 | $256.36 | $427.26 |