- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.01 / $376.69 / $964.32
| Facility | | $226.01 | $376.69 | $964.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.01 / $235.05 / $286.27
| Professional | | $226.01 | $235.05 | $286.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.69 / $397.78 / $593.66
| Professional | | $156.69 | $397.78 | $593.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.29 / $620.13 / $1,075.63
| Facility | | $172.29 | $620.13 | $1,075.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.40 / $201.65 / $513.41
| Professional | | $134.40 | $201.65 | $513.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.35 / $1,431.41 / $1,431.41
| Facility | | $524.35 | $1,431.41 | $1,431.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.75 / $1,506.75 / $2,260.13
| Professional | | $1,506.75 | $1,506.75 | $2,260.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $180.81 / $301.35
| Professional | | $126.57 | $180.81 | $301.35 |