- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.67 / $520.77 / $1,252.79
| Facility | | $333.67 | $520.77 | $1,252.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.87 / $228.69 / $317.27
| Professional | | $181.87 | $228.69 | $317.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.16 / $476.11 / $986.45
| Facility | | $289.16 | $476.11 | $986.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.07 / $180.07 / $284.62
| Professional | | $180.07 | $180.07 | $284.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.13 / $212.54 / $322.56
| Facility | | $115.13 | $212.54 | $322.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.57 / $641.84 / $641.84
| Professional | | $223.57 | $641.84 | $641.84 |