- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.44 / $834.44 / $874.27
| Professional | | $562.44 | $834.44 | $874.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.70 / $286.42 / $1,164.72
| Facility | | $226.70 | $286.42 | $1,164.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.18 / $1,237.06 / $1,619.78
| Professional | | $900.18 | $1,237.06 | $1,619.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.53 / $578.53 / $578.53
| Facility | | $578.53 | $578.53 | $578.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.77 / $1,768.50 / $2,633.48
| Professional | | $1,223.77 | $1,768.50 | $2,633.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.09 / $1,113.09 / $1,113.09
| Facility | | $1,113.09 | $1,113.09 | $1,113.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.76 / $1,131.54 / $2,150.42
| Professional | | $581.76 | $1,131.54 | $2,150.42 |