- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,981.07 / $5,011.87
| Facility | | $954.99 | $3,981.07 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $616.60 / $1,230.27
| Professional | | $346.74 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $416.87 / $691.83
| Professional | | $363.08 | $416.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $851.14
| Professional | | $457.09 | $645.65 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,677.35 / $7,585.78
| Facility | | $2,570.40 | $4,677.35 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $891.25
| Professional | | $363.08 | $524.81 | $891.25 |