- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.65 / $1,538.39 / $1,706.52
| Facility | | $840.65 | $1,538.39 | $1,706.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.11 / $924.72 / $1,614.05
| Professional | | $664.11 | $924.72 | $1,614.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.25 / $32.25 / $32.25
| Facility | | $32.25 | $32.25 | $32.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.25 / $32.25 / $32.25
| Professional | | $32.25 | $32.25 | $32.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $546.41 / $546.41 / $573.74
| Facility | | $546.41 | $546.41 | $573.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $966.01 / $1,207.51
| Professional | | $966.01 | $966.01 | $1,207.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $20.00
| Professional | | $17.00 | $20.00 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.59 / $756.59 / $840.65
| Facility | | $756.59 | $756.59 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.07 / $420.33 / $1,260.98
| Professional | | $353.07 | $420.33 | $1,260.98 |