- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.73 / $734.58 / $1,767.13
| Facility | | $517.73 | $734.58 | $1,767.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.02 / $632.65 / $910.24
| Professional | | $400.02 | $632.65 | $910.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.66 / $671.58 / $1,391.44
| Facility | | $470.66 | $671.58 | $1,391.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.34 / $552.29 / $834.74
| Professional | | $348.34 | $552.29 | $834.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.23 / $343.23 / $629.03
| Facility | | $321.23 | $343.23 | $629.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.00 / $3,126.00 / $3,126.00
| Professional | | $415.00 | $3,126.00 | $3,126.00 |