- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.77 / $486.30 / $1,070.86
| Facility | | $291.77 | $486.30 | $1,070.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.54 / $291.77 / $411.79
| Professional | | $251.54 | $291.77 | $411.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.38 / $428.47 / $1,160.41
| Facility | | $335.38 | $428.47 | $1,160.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.62 / $224.70 / $532.67
| Professional | | $165.62 | $224.70 | $532.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.12 / $588.60 / $1,112.68
| Facility | | $303.12 | $588.60 | $1,112.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.28 / $381.03 / $713.86
| Professional | | $205.28 | $381.03 | $713.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.86 / $201.23 / $457.54
| Professional | | $140.86 | $201.23 | $457.54 |