- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $1,380.38 / $2,884.03
| Facility | | $416.87 | $1,380.38 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $645.65
| Professional | | $346.74 | $407.38 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $2,344.23
| Facility | | $354.81 | $524.81 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $512.86 / $977.24
| Professional | | $269.15 | $512.86 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $575.44
| Professional | | $346.74 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $275.42 / $380.19
| Professional | | $69.18 | $275.42 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $575.44
| Facility | | $218.78 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $245.47 / $575.44
| Professional | | $204.17 | $245.47 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $575.44
| Professional | | $346.74 | $346.74 | $575.44 |