- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.32 / $396.58 / $1,445.56
| Facility | | $291.32 | $396.58 | $1,445.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.90 / $327.05 / $357.28
| Professional | | $164.90 | $327.05 | $357.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.58 / $536.72 / $845.71
| Facility | | $297.58 | $536.72 | $845.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $274.83 / $274.83
| Facility | | $274.83 | $274.83 | $274.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $221.33 / $2,086.55
| Facility | | $178.64 | $221.33 | $2,086.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $164.90 / $357.28
| Professional | | $115.43 | $164.90 | $357.28 |