- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.36 / $873.74 / $1,889.16
| Facility | | $590.36 | $873.74 | $1,889.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.49 / $582.49 / $590.36
| Professional | | $582.49 | $582.49 | $590.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.65 / $511.65 / $2,102.88
| Facility | | $511.65 | $511.65 | $2,102.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.74 / $958.74 / $1,148.68
| Professional | | $958.74 | $958.74 | $1,148.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.49 / $787.15 / $1,322.41
| Facility | | $582.49 | $787.15 | $1,322.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $330.60 / $2,955.93
| Professional | | $330.60 | $330.60 | $2,955.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $330.60 / $503.78
| Professional | | $330.60 | $330.60 | $503.78 |