- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.87 / $585.20 / $1,017.74
| Facility | | $508.87 | $585.20 | $1,017.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.92 / $585.20 / $585.20
| Professional | | $396.92 | $585.20 | $585.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.77 / $534.77 / $631.03
| Professional | | $534.77 | $534.77 | $631.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $413.46 / $1,595.81
| Facility | | $330.77 | $413.46 | $1,595.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.24 / $236.74 / $2,083.65
| Professional | | $212.24 | $236.74 | $2,083.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.73 / $213.73 / $508.87
| Professional | | $213.73 | $213.73 | $508.87 |