- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.56 / $1,553.97 / $2,037.37
| Facility | | $296.56 | $1,553.97 | $2,037.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.56 / $296.56 / $296.56
| Professional | | $296.56 | $296.56 | $296.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.64 / $289.67 / $907.91
| Facility | | $281.64 | $289.67 | $907.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $341.76 / $602.69
| Professional | | $151.36 | $341.76 | $602.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.51 / $378.94 / $1,334.52
| Facility | | $329.51 | $378.94 | $1,334.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.04 / $355.51 / $395.01
| Professional | | $324.04 | $355.51 | $395.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $138.38 / $197.71
| Professional | | $138.38 | $138.38 | $197.71 |