- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $4,677.35 / $14,125.38
| Facility | | $281.84 | $4,677.35 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $616.60
| Professional | | $281.84 | $281.84 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $776.25
| Facility | | $295.12 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $338.84 / $457.09
| Professional | | $281.84 | $338.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $389.05 / $436.52
| Facility | | $263.03 | $389.05 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $389.05
| Professional | | $288.40 | $363.08 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $288.40 / $562.34
| Facility | | $281.84 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $331.13 / $831.76
| Professional | | $281.84 | $331.13 | $831.76 |