- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $602.56 / $1,584.89
| Facility | | $295.12 | $602.56 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $309.03 / $602.56
| Professional | | $158.49 | $309.03 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $1,737.80
| Facility | | $316.23 | $489.78 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $812.83
| Professional | | $151.36 | $229.09 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $691.83 / $1,584.89
| Facility | | $151.36 | $691.83 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $446.68 / $912.01
| Professional | | $169.82 | $446.68 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $380.19 / $457.09
| Facility | | $138.04 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $158.49 / $380.19
| Professional | | $63.10 | $158.49 | $380.19 |