- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $831.76
| Facility | | $660.69 | $776.25 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $1,071.52
| Professional | | $30.20 | $47.86 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $645.65 / $1,023.29
| Professional | | $407.38 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,248.07 / $5,248.07
| Professional | | $2,454.71 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $54.95 / $85.11
| Professional | | $39.81 | $54.95 | $85.11 |