- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,071.52 / $2,187.76
| Facility | | $724.44 | $1,071.52 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $275.42 / $407.38
| Professional | | $128.82 | $275.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $371.54 / $478.63
| Professional | | $251.19 | $371.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $316.23
| Professional | | $181.97 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $295.12 / $3,090.30
| Facility | | $263.03 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $537.03
| Professional | | $173.78 | $302.00 | $537.03 |