- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $588.84 / $3,981.07
| Facility | | $323.59 | $588.84 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $223.87 / $380.19
| Professional | | $104.71 | $223.87 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $141.25 / $218.78
| Professional | | $93.33 | $141.25 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $177.83 / $275.42
| Professional | | $104.71 | $177.83 | $275.42 |
- 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
- $112.20 / $162.18 / $251.19
| Professional | | $112.20 | $162.18 | $251.19 |