- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.14 / $621.65 / $767.53
| Facility | | $610.14 | $621.65 | $767.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.77 / $648.92 / $915.67
| Professional | | $515.77 | $648.92 | $915.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.47 / $1,263.74 / $2,360.94
| Facility | | $1,180.47 | $1,263.74 | $2,360.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.02 / $657.04 / $1,051.16
| Professional | | $650.02 | $657.04 | $1,051.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.41 / $782.41 / $782.41
| Facility | | $782.41 | $782.41 | $782.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.16 / $765.59 / $805.88
| Professional | | $571.16 | $765.59 | $805.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.32 / $588.91 / $884.86
| Professional | | $435.32 | $588.91 | $884.86 |