- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,513.56 / $1,819.70
| Facility | | $426.58 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $602.56
| Professional | | $426.58 | $426.58 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $630.96 / $691.83
| Facility | | $588.84 | $630.96 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $1,737.80
| Facility | | $398.11 | $524.81 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $457.09 / $1,202.26
| Facility | | $426.58 | $457.09 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $269.15 / $645.65
| Facility | | $263.03 | $269.15 | $645.65 |