- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.33 / $1,866.33 / $1,866.33
| Facility | | $1,866.33 | $1,866.33 | $1,866.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.21 / $240.19 / $266.16
| Professional | | $227.21 | $240.19 | $266.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $382.29 / $415.46
| Facility | | $324.58 | $382.29 | $415.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.92 / $243.44 / $396.61
| Professional | | $206.92 | $243.44 | $396.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.48 / $861.48 / $861.48
| Facility | | $861.48 | $861.48 | $861.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.41 / $430.53 / $879.01
| Professional | | $161.41 | $430.53 | $879.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.31 / $194.75 / $468.14
| Professional | | $160.31 | $194.75 | $468.14 |