- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,318.26
| Facility | | $371.54 | $588.84 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $309.03 / $363.08
| Professional | | $245.47 | $309.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,122.02
| Facility | | $371.54 | $371.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $316.23
| Professional | | $151.36 | $151.36 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $346.74 / $537.03
| Facility | | $269.15 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $338.84 / $707.95
| Professional | | $162.18 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $223.87 / $371.54
| Professional | | $158.49 | $223.87 | $371.54 |