- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,513.56 / $2,187.76
| Facility | | $426.58 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $478.63
| Professional | | $371.54 | $426.58 | $478.63 |
- 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 / $1,258.93
| Facility | | $398.11 | $912.01 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $467.74 / $1,023.29
| Facility | | $426.58 | $467.74 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $831.76
| Facility | | $269.15 | $436.52 | $831.76 |