- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $467.74 / $3,981.07
| Facility | | $426.58 | $467.74 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $794.33
| Professional | | $234.42 | $316.23 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $501.19
| Professional | | $239.88 | $309.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $575.44
| Professional | | $281.84 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $602.56
| Professional | | $223.87 | $331.13 | $602.56 |