- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $616.60 / $7,244.36
| Facility | | $223.87 | $616.60 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $309.03
| Professional | | $223.87 | $223.87 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,995.26 / $3,235.94
| Facility | | $1,258.93 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $239.88 / $724.44
| Facility | | $204.17 | $239.88 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $524.81 / $912.01
| Facility | | $154.88 | $524.81 | $912.01 |