- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.41 / $456.41 / $456.41
| Facility | | $456.41 | $456.41 | $456.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.41 / $456.41 / $456.41
| Professional | | $456.41 | $456.41 | $456.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,370.41 / $1,675.77 / $5,305.16
| Facility | | $1,370.41 | $1,675.77 | $5,305.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.16 / $474.27 / $768.51
| Professional | | $394.16 | $474.27 | $768.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.60 / $309.67 / $431.56
| Professional | | $32.60 | $309.67 | $431.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.82 / $2,732.92 / $4,232.76
| Facility | | $2,161.82 | $2,732.92 | $4,232.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $603.29 / $858.52 / $929.10
| Professional | | $603.29 | $858.52 | $929.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.15 / $455.32 / $923.04
| Professional | | $362.15 | $455.32 | $923.04 |