- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,445.44 / $2,187.76
| Facility | | $426.58 | $1,445.44 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $602.56
| Professional | | $426.58 | $426.58 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $3.98 / $3.98
| Professional | | $3.98 | $3.98 | $3.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $912.01 / $1,778.28
| Facility | | $398.11 | $912.01 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $489.78 / $1,096.48
| Facility | | $426.58 | $489.78 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $831.76
| Facility | | $269.15 | $436.52 | $831.76 |