- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.31 / $488.52 / $1,175.21
| Facility | | $344.31 | $488.52 | $1,175.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.85 / $315.64 / $586.96
| Professional | | $163.85 | $315.64 | $586.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.04 / $446.63 / $925.36
| Facility | | $280.04 | $446.63 | $925.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.22 / $281.74 / $521.84
| Professional | | $162.22 | $281.74 | $521.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.57 / $253.57 / $253.57
| Facility | | $253.57 | $253.57 | $253.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.00 / $1,017.00 / $1,157.05
| Professional | | $347.00 | $1,017.00 | $1,157.05 |