- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,318.26 / $2,187.76
| Facility | | $309.03 | $1,318.26 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $478.63
| Professional | | $251.19 | $316.23 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $199.53 / $630.96
| Facility | | $190.55 | $199.53 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $776.25
| Professional | | $389.05 | $389.05 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $416.87 / $724.44
| Facility | | $295.12 | $416.87 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $60.26
| Professional | | $34.67 | $39.81 | $60.26 |