- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.51 / $993.48 / $1,490.22
| Facility | | $531.51 | $993.48 | $1,490.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.16 / $546.41 / $655.39
| Professional | | $546.16 | $546.41 | $655.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.21 / $1,281.49 / $2,476.25
| Facility | | $397.21 | $1,281.49 | $2,476.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.43 / $480.62 / $3,159.87
| Professional | | $330.43 | $480.62 | $3,159.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.77 / $496.74 / $496.74
| Facility | | $481.77 | $496.74 | $496.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $496.74
| Professional | | $496.74 | $496.74 | $496.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.51 / $655.39 / $781.01
| Facility | | $496.51 | $655.39 | $781.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.51 / $496.51 / $547.75
| Professional | | $496.51 | $496.51 | $547.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $496.74 / $496.74
| Professional | | $496.74 | $496.74 | $496.74 |