- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.47 / $762.79 / $1,062.06
| Facility | | $401.47 | $762.79 | $1,062.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.96 / $401.47 / $1,119.45
| Professional | | $386.96 | $401.47 | $1,119.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.82 / $427.27 / $1,285.83
| Facility | | $368.82 | $427.27 | $1,285.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.08 / $427.27 / $427.27
| Professional | | $403.08 | $427.27 | $427.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.15 / $411.15 / $411.15
| Facility | | $411.15 | $411.15 | $411.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.15 / $411.15 / $411.15
| Professional | | $411.15 | $411.15 | $411.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.47 / $411.15 / $483.70
| Professional | | $401.47 | $411.15 | $483.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.08 / $403.08 / $427.26
| Professional | | $403.08 | $403.08 | $427.26 |