- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,621.81
| Facility | | $478.63 | $676.08 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $346.74 / $537.03
| Professional | | $275.42 | $346.74 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $1,258.93
| Facility | | $524.81 | $645.65 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $426.58
| Professional | | $269.15 | $269.15 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $138.04 / $281.84
| Facility | | $112.20 | $138.04 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $724.44 / $724.44
| Professional | | $120.23 | $724.44 | $724.44 |