- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,071.52
| Facility | | $467.74 | $467.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $457.09
| Professional | | $257.04 | $346.74 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,258.93
| Facility | | $575.44 | $776.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $467.74 / $602.56
| Professional | | $239.88 | $467.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,621.81 / $2,344.23
| Facility | | $302.00 | $1,621.81 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $870.96 / $1,023.29
| Professional | | $630.96 | $870.96 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $812.83
| Professional | | $223.87 | $281.84 | $812.83 |