- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,760.83 / $7,244.36
| Facility | | $3,235.94 | $6,760.83 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $426.58
| Professional | | $144.54 | $234.42 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $416.87
| Professional | | $141.25 | $229.09 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $501.19
| Facility | | $144.54 | $144.54 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $213.80 / $354.81
| Professional | | $141.25 | $213.80 | $354.81 |