- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.22 / $563.77 / $1,356.23
| Facility | | $361.22 | $563.77 | $1,356.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.44 / $529.91 / $757.33
| Professional | | $314.44 | $529.91 | $757.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.02 / $514.48 / $1,067.90
| Facility | | $313.02 | $514.48 | $1,067.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.49 / $464.97 / $640.65
| Professional | | $282.49 | $464.97 | $640.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.86 / $233.28 / $431.70
| Facility | | $220.86 | $233.28 | $431.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.85 / $808.85 / $808.85
| Professional | | $808.85 | $808.85 | $808.85 |