- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.61 / $702.42 / $2,204.98
| Facility | | $355.61 | $702.42 | $2,204.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.07 / $355.61 / $480.81
| Professional | | $301.07 | $355.61 | $480.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.11 / $530.45 / $1,004.37
| Facility | | $511.11 | $530.45 | $1,004.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.65 / $384.66 / $548.72
| Professional | | $338.65 | $384.66 | $548.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.51 / $440.51 / $440.51
| Facility | | $440.51 | $440.51 | $440.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.51 / $440.51 / $440.51
| Professional | | $440.51 | $440.51 | $440.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.75 / $520.75 / $572.83
| Professional | | $520.75 | $520.75 | $572.83 |