- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.15 / $548.70 / $553.52
| Facility | | $501.15 | $548.70 | $553.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.16 / $522.66 / $674.73
| Professional | | $404.16 | $522.66 | $674.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.37 / $532.37 / $1,027.47
| Facility | | $532.37 | $532.37 | $1,027.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.37 / $544.17 / $758.04
| Professional | | $532.37 | $544.17 | $758.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.40 / $872.40 / $872.40
| Facility | | $872.40 | $872.40 | $872.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.51 / $643.37 / $1,068.75
| Professional | | $68.51 | $643.37 | $1,068.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.70 / $388.47 / $660.43
| Professional | | $308.70 | $388.47 | $660.43 |