- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $537.03 / $1,348.96
| Facility | | $263.03 | $537.03 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $524.81
| Professional | | $208.93 | $263.03 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $1,479.11
| Facility | | $281.84 | $407.38 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $158.49 / $1,380.38
| Professional | | $128.82 | $158.49 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $616.60 / $1,348.96
| Facility | | $208.93 | $616.60 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $389.05 / $776.25
| Professional | | $158.49 | $389.05 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $323.59 / $380.19
| Facility | | $190.55 | $323.59 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $190.55 / $380.19
| Professional | | $134.90 | $190.55 | $380.19 |