- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $1,862.09
| Facility | | $549.54 | $776.25 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $645.65 / $933.25
| Professional | | $416.87 | $645.65 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,445.44
| Facility | | $602.56 | $741.31 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $831.76
| Professional | | $398.11 | $524.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $676.08
| Facility | | $251.19 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $3,090.30 / $3,090.30
| Professional | | $416.87 | $3,090.30 | $3,090.30 |