- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,047.13 / $2,137.96
| Facility | | $562.34 | $1,047.13 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $575.44
| Professional | | $380.19 | $501.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,047.13 / $2,398.83
| Facility | | $467.74 | $1,047.13 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $660.69 / $851.14
| Professional | | $245.47 | $660.69 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $776.25
| Facility | | $257.04 | $257.04 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $575.44
| Professional | | $245.47 | $346.74 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $575.44 / $691.83
| Facility | | $245.47 | $575.44 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $575.44
| Professional | | $245.47 | $346.74 | $575.44 |