- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.57 / $1,197.30 / $1,836.68
| Facility | | $1,024.57 | $1,197.30 | $1,836.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.38 / $451.96 / $541.50
| Professional | | $426.38 | $451.96 | $541.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.07 / $454.07 / $710.68
| Facility | | $454.07 | $454.07 | $710.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.07 / $454.07 / $710.68
| Facility | | $454.07 | $454.07 | $710.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.07 / $454.07 / $710.68
| Facility | | $454.07 | $454.07 | $710.68 |