- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $849.60 / $1,595.22 / $2,464.92
| Facility | | $849.60 | $1,595.22 | $2,464.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.99 / $771.98 / $771.98
| Professional | | $578.99 | $771.98 | $771.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $964.98 / $964.98 / $964.98
| Professional | | $964.98 | $964.98 | $964.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.39 / $812.90 / $1,750.40
| Facility | | $507.39 | $812.90 | $1,750.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $887.12 / $896.00 / $1,126.65
| Professional | | $887.12 | $896.00 | $1,126.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.18 / $633.02 / $1,343.25
| Facility | | $463.18 | $633.02 | $1,343.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.23 / $463.19 / $1,312.37
| Professional | | $324.23 | $463.19 | $1,312.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.23 / $463.19 / $1,312.37
| Professional | | $324.23 | $463.19 | $1,312.37 |