- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.44 / $480.55 / $2,774.36
| Facility | | $384.44 | $480.55 | $2,774.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.44 / $416.47 / $461.33
| Professional | | $384.44 | $416.47 | $461.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.79 / $458.39 / $2,409.44
| Facility | | $321.79 | $458.39 | $2,409.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.63 / $709.13 / $886.41
| Professional | | $668.63 | $709.13 | $886.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.81 / $384.44 / $759.20
| Professional | | $358.81 | $384.44 | $759.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.73 / $640.73 / $961.10
| Facility | | $640.73 | $640.73 | $961.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.26 / $269.11 / $833.94
| Professional | | $224.26 | $269.11 | $833.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.90 / $384.44 / $384.44
| Professional | | $331.90 | $384.44 | $384.44 |