- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.07 / $573.39 / $2,666.49
| Facility | | $247.07 | $573.39 | $2,666.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.07 / $349.63 / $396.24
| Professional | | $247.07 | $349.63 | $396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.69 / $688.81 / $1,468.26
| Facility | | $455.69 | $688.81 | $1,468.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.48 / $610.67 / $849.36
| Professional | | $489.48 | $610.67 | $849.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.64 / $315.64 / $8,702.00
| Facility | | $315.64 | $315.64 | $8,702.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.10 / $466.17 / $956.84
| Facility | | $219.10 | $466.17 | $956.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.46 / $279.70 / $477.82
| Professional | | $193.46 | $279.70 | $477.82 |