- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.47 / $464.64 / $1,117.74
| Facility | | $327.47 | $464.64 | $1,117.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.46 / $210.78 / $534.10
| Professional | | $57.46 | $210.78 | $534.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.35 / $424.79 / $880.11
| Facility | | $266.35 | $424.79 | $880.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.84 / $173.17 / $447.66
| Professional | | $53.84 | $173.17 | $447.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.60 / $214.60 / $214.60
| Facility | | $214.60 | $214.60 | $214.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.00 / $638.00 / $687.43
| Professional | | $216.00 | $638.00 | $687.43 |