- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.66 / $5,379.48 / $5,990.53
| Facility | | $245.66 | $5,379.48 | $5,990.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.72 / $252.59 / $375.13
| Professional | | $229.72 | $252.59 | $375.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.66 / $510.83 / $612.38
| Professional | | $469.66 | $510.83 | $612.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.23 / $568.54 / $734.19
| Professional | | $295.23 | $568.54 | $734.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.66 / $480.06 / $3,625.95
| Facility | | $245.66 | $480.06 | $3,625.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.51 / $464.61 / $636.16
| Professional | | $255.51 | $464.61 | $636.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.51 / $494.86 / $636.16
| Professional | | $255.51 | $494.86 | $636.16 |