- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.62 / $568.47 / $1,071.16
| Facility | | $349.62 | $568.47 | $1,071.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.73 / $262.22 / $297.18
| Professional | | $244.73 | $262.22 | $297.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.62 / $386.33 / $1,136.89
| Facility | | $349.62 | $386.33 | $1,136.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.52 / $279.68 / $602.06
| Professional | | $211.52 | $279.68 | $602.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.51 / $1,124.64 / $1,814.00
| Facility | | $760.51 | $1,124.64 | $1,814.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.96 / $425.96 / $510.35
| Professional | | $425.96 | $425.96 | $510.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.66 / $332.14 / $419.54
| Facility | | $314.66 | $332.14 | $419.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $209.77 / $395.42
| Professional | | $146.84 | $209.77 | $395.42 |