- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $363.08 / $7,762.47
| Facility | | $346.74 | $363.08 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $245.47 / $575.44
| Professional | | $190.55 | $245.47 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $467.74
| Professional | | $245.47 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $562.34
| Facility | | $245.47 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $323.59 / $467.74
| Professional | | $245.47 | $323.59 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,148.15 / $1,412.54
| Facility | | $229.09 | $1,148.15 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $501.19
| Professional | | $263.03 | $338.84 | $501.19 |