- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $776.25 / $4,677.35
| Facility | | $316.23 | $776.25 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $316.23 / $524.81
| Professional | | $275.42 | $316.23 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $724.44 / $977.24
| Facility | | $616.60 | $724.44 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $977.24
| Facility | | $602.56 | $758.58 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Professional | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $645.65 / $758.58
| Facility | | $331.13 | $645.65 | $758.58 |