- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.68 / $861.61 / $1,088.52
| Facility | | $313.68 | $861.61 | $1,088.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.68 / $313.68 / $537.01
| Professional | | $313.68 | $313.68 | $537.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.12 / $474.86 / $755.82
| Facility | | $370.12 | $474.86 | $755.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.76 / $486.76 / $486.76
| Professional | | $486.76 | $486.76 | $486.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.20 / $683.75 / $981.62
| Facility | | $494.20 | $683.75 | $981.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.85 / $385.21 / $409.07
| Professional | | $323.85 | $385.21 | $409.07 |