- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $489.78 / $1,288.25
| Facility | | $245.47 | $489.78 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $251.19 / $407.38
| Professional | | $87.10 | $251.19 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $398.11 / $1,288.25
| Facility | | $245.47 | $398.11 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $123.03 / $426.58
| Professional | | $70.79 | $123.03 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $588.84 / $1,258.93
| Facility | | $141.25 | $588.84 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $354.81 / $741.31
| Professional | | $138.04 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $309.03 / $371.54
| Facility | | $128.82 | $309.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $128.82 / $316.23
| Professional | | $67.61 | $128.82 | $316.23 |