- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.43 / $434.85 / $1,585.06
| Facility | | $319.43 | $434.85 | $1,585.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $358.61 / $391.76
| Professional | | $180.81 | $358.61 | $391.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.30 / $588.51 / $927.31
| Facility | | $326.30 | $588.51 | $927.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.35 / $301.35 / $301.35
| Facility | | $301.35 | $301.35 | $301.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.88 / $242.70 / $2,287.23
| Facility | | $195.88 | $242.70 | $2,287.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $150.68 / $391.76
| Professional | | $126.57 | $150.68 | $391.76 |