- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $891.25 / $1,047.13
| Facility | | $316.23 | $891.25 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $794.33
| Professional | | $151.36 | $257.04 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $398.11 / $1,513.56
| Facility | | $199.53 | $398.11 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $218.78 / $691.83
| Professional | | $158.49 | $218.78 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $812.83 / $1,548.82
| Facility | | $263.03 | $812.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $346.74 / $524.81
| Professional | | $213.80 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $199.53 / $426.58
| Professional | | $102.33 | $199.53 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $245.47 / $416.87
| Professional | | $102.33 | $245.47 | $416.87 |