- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $2,951.21
| Facility | | $245.47 | $245.47 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $234.42 / $251.19
| Professional | | $218.78 | $234.42 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $616.60 / $912.01
| Facility | | $549.54 | $616.60 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $707.95
| Professional | | $338.84 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $338.84 / $426.58
| Professional | | $229.09 | $338.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $354.81
| Professional | | $204.17 | $316.23 | $354.81 |