- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.08 / $510.77 / $626.22
| Facility | | $508.08 | $510.77 | $626.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.66 / $515.01 / $735.34
| Professional | | $401.66 | $515.01 | $735.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.78 / $1,144.60 / $1,893.80
| Facility | | $874.78 | $1,144.60 | $1,893.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.40 / $534.42 / $794.46
| Professional | | $525.40 | $534.42 | $794.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.11 / $673.11 / $673.11
| Facility | | $673.11 | $673.11 | $673.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.37 / $658.66 / $693.30
| Professional | | $491.37 | $658.66 | $693.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.86 / $493.62 / $692.16
| Professional | | $373.86 | $493.62 | $692.16 |