- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.42 / $1,179.42 / $1,179.42
| Professional | | $1,179.42 | $1,179.42 | $1,179.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $330.77
| Facility | | $330.77 | $330.77 | $330.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $330.77 / $340.69
| Professional | | $281.14 | $330.77 | $340.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.68 / $393.55 / $583.52
| Facility | | $342.68 | $393.55 | $583.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.23 / $107.23 / $107.23
| Professional | | $107.23 | $107.23 | $107.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.47 / $367.30 / $788.56
| Professional | | $93.47 | $367.30 | $788.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.68 / $383.57 / $583.52
| Facility | | $342.68 | $383.57 | $583.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $330.77 / $340.69
| Professional | | $281.14 | $330.77 | $340.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.37 / $535.46 / $977.80
| Professional | | $279.37 | $535.46 | $977.80 |