- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,905.46
| Facility | | $562.34 | $794.33 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $645.65
| Professional | | $323.59 | $407.38 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $758.58 / $1,513.56
| Facility | | $616.60 | $758.58 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $501.19
| Professional | | $323.59 | $323.59 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $165.96 / $331.13
| Facility | | $125.89 | $165.96 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $851.14 / $851.14
| Professional | | $131.83 | $851.14 | $851.14 |