- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $2,238.72
| Facility | | $562.34 | $758.58 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $870.96
| Professional | | $501.19 | $588.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $1,995.26
| Facility | | $489.78 | $489.78 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,096.48
| Professional | | $912.01 | $912.01 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,318.26
| Facility | | $549.54 | $758.58 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $2,818.38
| Professional | | $316.23 | $316.23 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $758.58 / $891.25
| Facility | | $316.23 | $758.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $489.78
| Professional | | $316.23 | $316.23 | $489.78 |