- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.52 / $672.52 / $1,395.48
| Facility | | $672.52 | $672.52 | $1,395.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.46 / $672.52 / $672.52
| Professional | | $588.46 | $672.52 | $672.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.76 / $1,560.13 / $2,207.17
| Facility | | $638.76 | $1,560.13 | $2,207.17 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $504.39 / $672.52 / $840.65
| Facility | | $504.39 | $672.52 | $840.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.41 / $840.65 / $840.65
| Professional | | $546.41 | $840.65 | $840.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.39 / $991.97 / $1,008.78
| Facility | | $504.39 | $991.97 | $1,008.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.29 / $420.33 / $840.65
| Professional | | $378.29 | $420.33 | $840.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.73 / $3,993.09 / $3,993.09
| Facility | | $1,462.73 | $3,993.09 | $3,993.09 |