- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,187.76 / $2,884.03
| Facility | | $407.38 | $2,187.76 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $575.44
| Professional | | $245.47 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $363.08 / $1,122.02
| Facility | | $346.74 | $363.08 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $741.31 / $2,187.76
| Facility | | $407.38 | $741.31 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $512.86
| Professional | | $346.74 | $407.38 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $407.38
| Professional | | $288.40 | $288.40 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $363.08 / $616.60
| Professional | | $323.59 | $363.08 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $190.55 / $245.47
| Professional | | $173.78 | $190.55 | $245.47 |