- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.45 / $640.22 / $1,540.13
| Facility | | $451.45 | $640.22 | $1,540.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.74 / $345.47 / $571.10
| Professional | | $274.74 | $345.47 | $571.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.48 / $585.30 / $1,212.70
| Facility | | $355.48 | $585.30 | $1,212.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.02 / $272.02 / $499.71
| Professional | | $272.02 | $272.02 | $499.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.39 / $118.68 / $279.45
| Facility | | $112.39 | $118.68 | $279.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.48 / $720.48 / $720.48
| Professional | | $720.48 | $720.48 | $720.48 |