- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $316.23 / $7,762.47
| Facility | | $48.98 | $316.23 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $295.12 / $660.69
| Professional | | $234.42 | $295.12 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $346.74 / $977.24
| Professional | | $275.42 | $346.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $354.81 / $776.25
| Professional | | $263.03 | $354.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $707.95
| Professional | | $389.05 | $575.44 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,548.82
| Facility | | $213.80 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $354.81 / $776.25
| Professional | | $199.53 | $354.81 | $776.25 |