- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $630.96 / $676.08
| Facility | | $537.03 | $630.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $870.96
| Professional | | $30.20 | $47.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $524.81 / $831.76
| Professional | | $331.13 | $524.81 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,365.16 / $4,365.16
| Professional | | $2,041.74 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $54.95 / $85.11
| Professional | | $39.81 | $54.95 | $85.11 |