- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.58 / $519.48 / $1,009.25
| Facility | | $303.58 | $519.48 | $1,009.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.52 / $274.52 / $356.12
| Professional | | $253.52 | $274.52 | $356.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.95 / $411.32 / $1,117.44
| Facility | | $322.95 | $411.32 | $1,117.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.49 / $159.49 / $419.16
| Professional | | $159.49 | $159.49 | $419.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.28 / $513.14 / $982.28
| Facility | | $252.28 | $513.14 | $982.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.67 / $370.87 / $481.93
| Professional | | $204.67 | $370.87 | $481.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $193.78 / $443.93
| Professional | | $135.63 | $193.78 | $443.93 |