- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.35 / $1,648.58 / $1,740.94
| Facility | | $160.35 | $1,648.58 | $1,740.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.18 / $160.35 / $299.36
| Professional | | $110.18 | $160.35 | $299.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.06 / $272.24 / $354.29
| Professional | | $211.06 | $272.24 | $354.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.66 / $264.14 / $477.86
| Professional | | $138.66 | $264.14 | $477.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.00 / $481.05 / $1,170.28
| Facility | | $152.00 | $481.05 | $1,170.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.75 / $317.72 / $385.05
| Professional | | $174.75 | $317.72 | $385.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.75 / $317.72 / $385.05
| Professional | | $174.75 | $317.72 | $385.05 |