- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $794.33 / $2,041.74
| Facility | | $208.93 | $794.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $275.42 / $436.52
| Professional | | $138.04 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $457.09
| Professional | | $346.74 | $346.74 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $676.08
| Professional | | $190.55 | $338.84 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $331.13 / $851.14
| Facility | | $128.82 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $309.03 / $588.84
| Professional | | $154.88 | $309.03 | $588.84 |