- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.32 / $656.68 / $985.02
| Facility | | $351.32 | $656.68 | $985.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $331.62 / $399.86
| Professional | | $328.34 | $331.62 | $399.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.61 / $948.90 / $1,646.15
| Facility | | $251.61 | $948.90 | $1,646.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.22 / $315.20 / $342.79
| Professional | | $293.22 | $315.20 | $342.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.80 / $328.34 / $357.28
| Facility | | $324.80 | $328.34 | $357.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $328.34 / $328.34
| Professional | | $328.34 | $328.34 | $328.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.92 / $385.32 / $1,315.96
| Facility | | $302.92 | $385.32 | $1,315.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.92 / $302.92 / $6,027.78
| Professional | | $302.92 | $302.92 | $6,027.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $328.34 / $348.04
| Professional | | $328.34 | $328.34 | $348.04 |