- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.12 / $743.50 / $1,175.82
| Facility | | $45.12 | $743.50 | $1,175.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.54 / $233.54 / $289.30
| Professional | | $233.54 | $233.54 | $289.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.56 / $226.56 / $226.56
| Facility | | $226.56 | $226.56 | $226.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.39 / $541.39 / $541.39
| Professional | | $541.39 | $541.39 | $541.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,161.41 / $1,161.41 / $2,241.38
| Facility | | $1,161.41 | $1,161.41 | $2,241.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.40 / $237.02 / $766.83
| Professional | | $146.40 | $237.02 | $766.83 |