- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.46 / $966.07 / $1,345.09
| Facility | | $508.46 | $966.07 | $1,345.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.46 / $508.46 / $520.71
| Professional | | $508.46 | $508.46 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.11 / $539.91 / $1,628.50
| Facility | | $467.11 | $539.91 | $1,628.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $520.71 / $520.71
| Professional | | $510.50 | $520.71 | $520.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $539.52
| Facility | | $520.71 | $520.71 | $539.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $520.71
| Professional | | $520.71 | $520.71 | $520.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.71 / $520.71 / $612.60
| Professional | | $520.71 | $520.71 | $612.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.16 / $596.16 / $596.16
| Facility | | $596.16 | $596.16 | $596.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.50 / $510.50 / $510.50
| Professional | | $510.50 | $510.50 | $510.50 |