- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.84 / $942.41 / $2,267.09
| Facility | | $561.84 | $942.41 | $2,267.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.12 / $413.84 / $574.16
| Professional | | $329.12 | $413.84 | $574.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.05 / $861.59 / $1,785.11
| Facility | | $515.05 | $861.59 | $1,785.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.86 / $325.86 / $515.05
| Professional | | $325.86 | $325.86 | $515.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.53 / $1,120.53 / $1,120.53
| Facility | | $1,120.53 | $1,120.53 | $1,120.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $963.73 / $963.73 / $963.73
| Professional | | $963.73 | $963.73 | $963.73 |