- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.22 / $678.71 / $13,825.46
| Facility | | $399.22 | $678.71 | $13,825.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.21 / $231.71 / $264.08
| Professional | | $137.21 | $231.71 | $264.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.19 / $184.19 / $184.19
| Facility | | $184.19 | $184.19 | $184.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.31 / $226.33 / $458.57
| Professional | | $140.31 | $226.33 | $458.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.00 / $440.00 / $440.00
| Facility | | $440.00 | $440.00 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.39 / $237.32 / $580.98
| Professional | | $210.39 | $237.32 | $580.98 |