- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.84 / $758.47 / $1,824.59
| Facility | | $534.84 | $758.47 | $1,824.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.49 / $409.27 / $676.58
| Professional | | $325.49 | $409.27 | $676.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.13 / $693.42 / $1,436.69
| Facility | | $421.13 | $693.42 | $1,436.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.26 / $322.26 / $592.01
| Professional | | $322.26 | $322.26 | $592.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.22 / $132.16 / $328.91
| Facility | | $125.22 | $132.16 | $328.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.67 / $852.67 / $852.67
| Professional | | $852.67 | $852.67 | $852.67 |