- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.12 / $933.75 / $1,066.09
| Facility | | $308.12 | $933.75 | $1,066.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.84 / $119.47 / $149.21
| Professional | | $102.84 | $119.47 | $149.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.07 / $153.24 / $211.49
| Professional | | $142.07 | $153.24 | $211.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.51 / $177.95 / $251.16
| Professional | | $116.51 | $177.95 | $251.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.91 / $168.83 / $258.99
| Professional | | $145.91 | $168.83 | $258.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.12 / $933.75 / $1,066.09
| Facility | | $308.12 | $933.75 | $1,066.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.84 / $119.47 / $149.21
| Professional | | $102.84 | $119.47 | $149.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.36 / $160.43 / $230.74
| Professional | | $108.36 | $160.43 | $230.74 |