- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,122.02 / $2,187.76
| Facility | | $281.84 | $1,122.02 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $316.23 / $398.11
| Professional | | $245.47 | $316.23 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $1,659.59
| Facility | | $208.93 | $309.03 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $1,949.84
| Professional | | $501.19 | $588.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $346.74
| Professional | | $245.47 | $245.47 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $363.08
| Professional | | $245.47 | $331.13 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $363.08 / $407.38
| Facility | | $169.82 | $363.08 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $169.82 / $616.60
| Professional | | $141.25 | $169.82 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $245.47 / $245.47
| Professional | | $109.65 | $245.47 | $245.47 |