- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.71 / $518.28 / $1,243.86
| Facility | | $388.71 | $518.28 | $1,243.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.53 / $440.54 / $518.28
| Professional | | $383.53 | $440.54 | $518.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.68 / $1,387.68 / $1,387.68
| Facility | | $1,387.68 | $1,387.68 | $1,387.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.37 / $492.37 / $492.37
| Professional | | $492.37 | $492.37 | $492.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.88 / $336.88 / $1,384.58
| Facility | | $336.88 | $336.88 | $1,384.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.34 / $276.41 / $756.34
| Professional | | $216.34 | $276.41 | $756.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.53 / $518.28 / $870.71
| Facility | | $383.53 | $518.28 | $870.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.68 / $217.68 / $777.42
| Professional | | $217.68 | $217.68 | $777.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.68 / $217.68 / $331.70
| Professional | | $217.68 | $217.68 | $331.70 |