- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,862.09
| Facility | | $478.63 | $660.69 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $645.65 / $977.24
| Professional | | $467.74 | $645.65 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $645.65 / $2,570.40
| Facility | | $478.63 | $645.65 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $1,412.54
| Professional | | $616.60 | $660.69 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $5,128.61
| Facility | | $776.25 | $776.25 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,949.84
| Professional | | $562.34 | $562.34 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,412.54
| Facility | | $398.11 | $691.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $977.24
| Professional | | $407.38 | $549.54 | $977.24 |