- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.72 / $383.40 / $2,213.50
| Facility | | $306.72 | $383.40 | $2,213.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.72 / $332.28 / $368.06
| Professional | | $306.72 | $332.28 | $368.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.32 / $353.25 / $1,922.72
| Facility | | $252.32 | $353.25 | $1,922.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.29 / $623.22 / $779.03
| Professional | | $587.29 | $623.22 | $779.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.33 / $306.72 / $605.72
| Professional | | $290.33 | $306.72 | $605.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.92 / $214.70 / $665.35
| Professional | | $178.92 | $214.70 | $665.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.80 / $306.72 / $306.72
| Professional | | $264.80 | $306.72 | $306.72 |