- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $973.21 / $1,692.54
| Facility | | $846.27 | $973.21 | $1,692.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.09 / $973.21 / $973.21
| Professional | | $660.09 | $973.21 | $973.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.45 / $687.60 / $2,653.52
| Facility | | $398.45 | $687.60 | $2,653.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.42 / $376.63 / $1,933.54
| Professional | | $366.42 | $376.63 | $1,933.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $355.43 / $507.76
| Professional | | $355.43 | $355.43 | $507.76 |