- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.14 / $673.35 / $980.77
| Facility | | $612.14 | $673.35 | $980.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.32 / $591.01 / $930.45
| Professional | | $120.32 | $591.01 | $930.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.74 / $424.36 / $663.06
| Professional | | $117.74 | $424.36 | $663.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.09 / $612.14 / $995.80
| Facility | | $392.09 | $612.14 | $995.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.02 / $1,004.73 / $3,657.26
| Professional | | $254.02 | $1,004.73 | $3,657.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.07 / $1,004.73 / $1,476.05
| Professional | | $810.07 | $1,004.73 | $1,476.05 |