- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.62 / $674.42 / $1,201.20
| Facility | | $294.62 | $674.42 | $1,201.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.42 / $450.54 / $812.67
| Professional | | $170.42 | $450.54 | $812.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.08 / $606.46 / $1,607.00
| Facility | | $388.08 | $606.46 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.39 / $465.55 / $773.37
| Facility | | $366.39 | $465.55 | $773.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |