- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.58 / $1,059.83 / $2,179.12
| Facility | | $532.58 | $1,059.83 | $2,179.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $593.47 / $727.69
| Professional | | $529.89 | $593.47 | $727.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.58 / $930.38 / $1,695.65
| Facility | | $577.58 | $930.38 | $1,695.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.90 / $499.90 / $753.67
| Facility | | $499.90 | $499.90 | $753.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.58 / $561.67 / $878.98
| Facility | | $532.58 | $561.67 | $878.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.42 / $582.88 / $869.02
| Professional | | $397.42 | $582.88 | $869.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |