- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.87 / $931.23 / $1,210.33
| Facility | | $508.87 | $931.23 | $1,210.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.01 / $931.23 / $1,033.01
| Professional | | $402.01 | $931.23 | $1,033.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.87 / $508.87 / $508.87
| Facility | | $508.87 | $508.87 | $508.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.87 / $508.87 / $508.87
| Professional | | $508.87 | $508.87 | $508.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $347.31 / $426.69
| Facility | | $330.77 | $347.31 | $426.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.79 / $396.29 / $860.79
| Professional | | $217.79 | $396.29 | $860.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.73 / $297.18 / $836.16
| Professional | | $213.73 | $297.18 | $836.16 |