- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.22 / $659.45 / $936.61
| Facility | | $621.22 | $659.45 | $936.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.72 / $659.45 / $955.72
| Professional | | $540.72 | $659.45 | $955.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.45 / $1,709.11 / $2,402.39
| Facility | | $1,000.45 | $1,709.11 | $2,402.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.27 / $816.08 / $816.08
| Professional | | $682.27 | $816.08 | $816.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,006.47 / $1,006.47 / $1,006.47
| Facility | | $1,006.47 | $1,006.47 | $1,006.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.43 / $895.43 / $895.43
| Facility | | $895.43 | $895.43 | $895.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.66 / $895.43 / $895.43
| Professional | | $653.66 | $895.43 | $895.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.82 / $596.02 / $857.13
| Professional | | $370.82 | $596.02 | $857.13 |