- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $977.24 / $1,584.89
| Facility | | $281.84 | $977.24 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $229.09 / $281.84
| Professional | | $169.82 | $229.09 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $812.83 / $1,380.38
| Facility | | $363.08 | $812.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $288.40
| Professional | | $117.49 | $117.49 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $181.97 / $870.96
| Facility | | $151.36 | $181.97 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $416.87
| Professional | | $346.74 | $346.74 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Professional | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $281.84
| Professional | | $199.53 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $169.82
| Professional | | $117.49 | $117.49 | $169.82 |