- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.49 / $630.49 / $5,144.78
| Facility | | $630.49 | $630.49 | $5,144.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.49 / $630.49 / $655.71
| Professional | | $630.49 | $630.49 | $655.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672.52 / $672.52 / $672.52
| Professional | | $672.52 | $672.52 | $672.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.05 / $1,420.69 / $3,055.66
| Facility | | $1,366.05 | $1,420.69 | $3,055.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.63 / $1,207.51 / $6,549.62
| Professional | | $460.63 | $1,207.51 | $6,549.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.75 / $1,708.79 / $1,708.79
| Professional | | $966.75 | $1,708.79 | $1,708.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.06 / $504.39 / $939.07
| Professional | | $248.06 | $504.39 | $939.07 |