- 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
- $263.03 / $363.08 / $549.54
| Professional | | $263.03 | $363.08 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $1,445.44
| Facility | | $891.25 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $467.74
| Professional | | $218.78 | $363.08 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $398.11 / $758.58
| Professional | | $269.15 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $562.34 / $1,548.82
| Facility | | $251.19 | $562.34 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $575.44
| Professional | | $251.19 | $354.81 | $575.44 |