- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,698.24 / $4,168.69
| Facility | | $676.08 | $1,698.24 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $602.56 / $676.08
| Professional | | $562.34 | $602.56 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $338.84 / $562.34
| Facility | | $194.98 | $338.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $501.19 / $1,202.26
| Facility | | $190.55 | $501.19 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $158.49 / $2,884.03
| Professional | | $154.88 | $158.49 | $2,884.03 |