- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.75 / $325.08 / $1,976.55
| Facility | | $291.75 | $325.08 | $1,976.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.08 / $325.08 / $333.42
| Professional | | $325.08 | $325.08 | $333.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $437.62 / $575.16
| Professional | | $416.78 | $437.62 | $575.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.46 / $1,026.75 / $2,376.42
| Facility | | $757.46 | $1,026.75 | $2,376.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.92 / $416.78 / $445.95
| Facility | | $320.92 | $416.78 | $445.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $208.39 / $379.52
| Professional | | $175.05 | $208.39 | $379.52 |