- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.47 / $554.61 / $2,286.73
| Facility | | $137.47 | $554.61 | $2,286.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.18 / $251.54 / $665.12
| Professional | | $248.18 | $251.54 | $665.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.83 / $335.38 / $425.93
| Professional | | $301.83 | $335.38 | $425.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.73 / $257.87 / $824.12
| Professional | | $183.73 | $257.87 | $824.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.38 / $402.46 / $639.91
| Professional | | $335.38 | $402.46 | $639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.91 / $192.17 / $305.19
| Professional | | $150.91 | $192.17 | $305.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.69 / $329.17 / $329.17
| Professional | | $167.69 | $329.17 | $329.17 |