- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $776.25 / $1,202.26
| Facility | | $295.12 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $5,623.41
| Facility | | $2,187.76 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $478.63 / $1,479.11
| Facility | | $218.78 | $478.63 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $602.56 / $758.58
| Professional | | $363.08 | $602.56 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,230.27 / $4,570.88
| Facility | | $281.84 | $1,230.27 | $4,570.88 |