- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $1,584.89
| Facility | | $446.68 | $588.84 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $562.34 / $933.25
| Professional | | $457.09 | $562.34 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $2,344.23
| Facility | | $457.09 | $616.60 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $616.60 / $1,318.26
| Professional | | $549.54 | $616.60 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $3,715.35
| Facility | | $616.60 | $616.60 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $1,445.44
| Professional | | $457.09 | $457.09 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $645.65 / $1,348.96
| Facility | | $380.19 | $645.65 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $524.81 / $870.96
| Professional | | $389.05 | $524.81 | $870.96 |