- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,318.26 / $1,445.44
| Facility | | $724.44 | $1,318.26 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $562.34 / $794.33
| Professional | | $478.63 | $562.34 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $977.24 / $977.24
| Facility | | $933.25 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $489.78 / $549.54
| Facility | | $467.74 | $489.78 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $870.96
| Facility | | $645.65 | $645.65 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $436.52 / $1,621.81
| Professional | | $302.00 | $436.52 | $1,621.81 |