- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $1,548.82
| Facility | | $380.19 | $512.86 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $512.86
| Professional | | $338.84 | $389.05 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $1,380.38
| Facility | | $331.13 | $331.13 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $741.31
| Professional | | $588.84 | $588.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $1,698.24
| Facility | | $309.03 | $407.38 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $512.86
| Professional | | $213.80 | $213.80 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $354.81 / $616.60
| Facility | | $128.82 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $309.03
| Professional | | $213.80 | $213.80 | $309.03 |