- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.85 / $1,174.58 / $1,302.96
| Facility | | $641.85 | $1,174.58 | $1,302.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.06 / $1,174.58 / $1,302.96
| Professional | | $507.06 | $1,174.58 | $1,302.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.55 / $516.55 / $516.55
| Facility | | $516.55 | $516.55 | $516.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.55 / $516.55 / $516.55
| Professional | | $516.55 | $516.55 | $516.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.86 / $429.37 / $538.19
| Facility | | $233.86 | $429.37 | $538.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.64 / $395.82 / $1,098.54
| Professional | | $274.64 | $395.82 | $1,098.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.91 / $287.83 / $750.90
| Professional | | $143.91 | $287.83 | $750.90 |