- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $1,230.27
| Facility | | $416.87 | $549.54 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $851.14
| Professional | | $407.38 | $549.54 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $588.84 / $2,238.72
| Facility | | $436.52 | $588.84 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $1,202.26
| Professional | | $501.19 | $616.60 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $3,548.13
| Facility | | $602.56 | $602.56 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $1,380.38
| Professional | | $436.52 | $436.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $724.44 / $1,288.25
| Facility | | $478.63 | $724.44 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $794.33
| Professional | | $380.19 | $501.19 | $794.33 |