- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $512.86 / $1,023.29
| Facility | | $380.19 | $512.86 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $512.86 / $870.96
| Professional | | $371.54 | $512.86 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $2,137.96
| Facility | | $398.11 | $537.03 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $537.03 / $1,148.15
| Professional | | $524.81 | $537.03 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $3,890.45
| Facility | | $676.08 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $1,513.56
| Professional | | $489.78 | $489.78 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $660.69 / $1,202.26
| Facility | | $575.44 | $660.69 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $724.44
| Professional | | $346.74 | $489.78 | $724.44 |