- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.45 / $975.60 / $1,210.50
| Facility | | $458.45 | $975.60 | $1,210.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $572.36
| Professional | | $416.78 | $416.78 | $572.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.46 / $625.16 / $9,377.54
| Facility | | $458.46 | $625.16 | $9,377.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $562.65 / $687.69
| Professional | | $416.78 | $562.65 | $687.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.64 / $406.37 / $500.14
| Facility | | $338.64 | $406.37 | $500.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.88 / $2,008.88 / $2,008.88
| Professional | | $2,008.88 | $2,008.88 | $2,008.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.25 / $1,001.91 / $1,905.70
| Facility | | $570.25 | $1,001.91 | $1,905.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.75 / $178.62 / $623.67
| Professional | | $160.75 | $178.62 | $623.67 |