- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.33 / $1,638.92 / $1,884.74
| Facility | | $727.33 | $1,638.92 | $1,884.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.14 / $682.14 / $1,144.77
| Professional | | $682.14 | $682.14 | $1,144.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.30 / $135.06 / $135.06
| Facility | | $101.30 | $135.06 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.31 / $133.71 / $135.06
| Professional | | $128.31 | $133.71 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.75 / $154.69 / $724.77
| Professional | | $123.75 | $154.69 | $724.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.21 / $1,296.07 / $2,382.75
| Facility | | $526.21 | $1,296.07 | $2,382.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.50 / $710.56 / $710.56
| Professional | | $639.50 | $710.56 | $710.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.68 / $617.39 / $617.39
| Facility | | $221.68 | $617.39 | $617.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.68 / $221.68 / $617.39
| Professional | | $221.68 | $221.68 | $617.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.03 / $710.56 / $710.56
| Professional | | $675.03 | $710.56 | $710.56 |