- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $537.03 / $1,412.54
| Facility | | $257.04 | $537.03 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $251.19 / $457.09
| Professional | | $199.53 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $1,412.54
| Facility | | $309.03 | $407.38 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $154.88 / $501.19
| Professional | | $123.03 | $154.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $588.84 / $1,348.96
| Facility | | $199.53 | $588.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $354.81 / $741.31
| Professional | | $147.91 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $309.03 / $371.54
| Facility | | $186.21 | $309.03 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $186.21 / $371.54
| Professional | | $128.82 | $186.21 | $371.54 |