- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $683.30 / $1,194.45
| Facility | | $324.58 | $683.30 | $1,194.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.75 / $246.68 / $305.11
| Professional | | $194.75 | $246.68 | $305.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.02 / $905.58 / $1,493.07
| Facility | | $343.02 | $905.58 | $1,493.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $136.32 / $324.58
| Professional | | $136.32 | $136.32 | $324.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.66 / $217.31 / $991.61
| Facility | | $185.66 | $217.31 | $991.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.22 / $175.94 / $471.00
| Professional | | $145.22 | $175.94 | $471.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.68 / $345.35 / $454.41
| Facility | | $246.68 | $345.35 | $454.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.66 / $460.90 / $1,197.70
| Professional | | $259.66 | $460.90 | $1,197.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $136.32 / $194.75
| Professional | | $136.32 | $136.32 | $194.75 |