- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.38 / $507.62 / $1,153.41
| Facility | | $411.38 | $507.62 | $1,153.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.58 / $319.11 / $326.80
| Professional | | $307.58 | $319.11 | $326.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.13 / $1,034.73 / $1,813.11
| Facility | | $277.13 | $1,034.73 | $1,813.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.27 / $326.02 / $366.79
| Professional | | $285.27 | $326.02 | $366.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.80 / $326.80 / $326.80
| Facility | | $326.80 | $326.80 | $326.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.80 / $326.80 / $326.80
| Professional | | $326.80 | $326.80 | $326.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.42 / $342.56 / $535.64
| Facility | | $311.42 | $342.56 | $535.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $695.25
| Professional | | $320.39 | $320.39 | $695.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $320.39
| Professional | | $320.39 | $320.39 | $320.39 |