- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $1,737.80 / $2,344.23
| Facility | | $251.19 | $1,737.80 | $2,344.23 |
- 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 / $190.55 / $1,096.48
| Facility | | $190.55 | $190.55 | $1,096.48 |
- 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 / $851.14
| Facility | | $295.12 | $416.87 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $60.26
| Professional | | $34.67 | $39.81 | $60.26 |