- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $537.03 / $1,819.70
| Facility | | $436.52 | $537.03 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $436.52 / $660.69
| Professional | | $389.05 | $436.52 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $575.44 / $575.44
| Professional | | $316.23 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,288.25 / $1,819.70
| Facility | | $380.19 | $1,288.25 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $851.14
| Professional | | $245.47 | $275.42 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $346.74 / $575.44
| Facility | | $208.93 | $346.74 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $346.74 / $575.44
| Professional | | $204.17 | $346.74 | $575.44 |