- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.58 / $444.19 / $1,202.39
| Facility | | $274.58 | $444.19 | $1,202.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.40 / $226.01 / $256.14
| Professional | | $200.40 | $226.01 | $256.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.68 / $788.70 / $1,249.41
| Facility | | $207.68 | $788.70 | $1,249.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.73 / $287.61 / $1,393.10
| Professional | | $197.73 | $287.61 | $1,393.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.30 / $489.70 / $881.46
| Facility | | $201.30 | $489.70 | $881.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.90 / $301.35 / $550.41
| Facility | | $201.90 | $301.35 | $550.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $1,500.72
| Professional | | $126.57 | $126.57 | $1,500.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $180.81
| Professional | | $126.57 | $126.57 | $180.81 |