- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.12 / $1,220.60 / $2,006.86
| Facility | | $292.12 | $1,220.60 | $2,006.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.12 / $292.12 / $292.12
| Professional | | $292.12 | $292.12 | $292.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.44 / $285.35 / $894.34
| Facility | | $277.44 | $285.35 | $894.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.11 / $336.90 / $593.70
| Professional | | $149.11 | $336.90 | $593.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $373.27 / $1,314.55
| Facility | | $324.58 | $373.27 | $1,314.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.20 / $350.13 / $389.03
| Professional | | $319.20 | $350.13 | $389.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $136.32 / $194.75
| Professional | | $136.32 | $136.32 | $194.75 |