- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,445.44 / $2,137.96
| Facility | | $426.58 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $524.81
| Professional | | $371.54 | $426.58 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $467.74 / $467.74
| Facility | | $234.42 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $3.98 / $4.57
| Professional | | $3.39 | $3.98 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $354.81
| Facility | | $257.04 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Professional | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $616.60
| Facility | | $302.00 | $302.00 | $616.60 |