- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $436.52
| Professional | | $151.36 | $239.88 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,818.38 / $3,890.45
| Facility | | $2,398.83 | $2,818.38 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $316.23
| Professional | | $154.88 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $245.47 / $549.54
| Professional | | $154.88 | $245.47 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,174.90 / $2,511.89
| Facility | | $398.11 | $1,174.90 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $371.54
| Professional | | $131.83 | $208.93 | $371.54 |