- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.96 / $713.16 / $838.89
| Facility | | $710.96 | $713.16 | $838.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.49 / $731.01 / $1,015.52
| Professional | | $610.49 | $731.01 | $1,015.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.46 / $1,478.05 / $2,683.54
| Facility | | $1,315.46 | $1,478.05 | $2,683.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $770.32 / $792.54 / $1,079.18
| Professional | | $770.32 | $792.54 | $1,079.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.86 / $830.86 / $917.34
| Facility | | $830.86 | $830.86 | $917.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.53 / $830.86 / $885.74
| Professional | | $606.53 | $830.86 | $885.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.64 / $876.64 / $876.64
| Facility | | $876.64 | $876.64 | $876.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.72 / $656.27 / $1,073.80
| Professional | | $543.72 | $656.27 | $1,073.80 |