- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.84 / $742.76 / $1,269.68
| Facility | | $634.84 | $742.76 | $1,269.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.61 / $742.76 / $742.76
| Professional | | $539.61 | $742.76 | $742.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $44.39 / $59.72
| Facility | | $36.58 | $44.39 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.11 / $42.61 / $411.92
| Professional | | $36.11 | $42.61 | $411.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.65 / $515.80 / $1,374.12
| Facility | | $412.65 | $515.80 | $1,374.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.63 / $266.63 / $380.90
| Professional | | $266.63 | $266.63 | $380.90 |