- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.85 / $738.13 / $1,283.70
| Facility | | $641.85 | $738.13 | $1,283.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.64 / $738.13 / $738.13
| Professional | | $500.64 | $738.13 | $738.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.36 / $641.85 / $757.38
| Professional | | $295.36 | $641.85 | $757.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.81 / $521.50 / $2,012.73
| Facility | | $181.81 | $521.50 | $2,012.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.19 / $285.63 / $1,177.47
| Professional | | $127.19 | $285.63 | $1,177.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.31 / $269.58 / $385.11
| Professional | | $158.31 | $269.58 | $385.11 |