- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $11,099.86
| Facility | | $461.62 | $461.62 | $11,099.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $461.62
| Professional | | $461.62 | $461.62 | $461.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.48 / $701.48 / $701.48
| Facility | | $701.48 | $701.48 | $701.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Professional | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.65 / $673.61 / $951.72
| Facility | | $531.65 | $673.61 | $951.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.57 / $511.40 / $543.08
| Professional | | $452.57 | $511.40 | $543.08 |