- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $478.63 / $1,258.93
| Facility | | $234.42 | $478.63 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $316.23
| Professional | | $181.97 | $223.87 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $512.86 / $1,380.38
| Facility | | $275.42 | $512.86 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $229.09 / $436.52
| Professional | | $173.78 | $229.09 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $524.81 / $1,230.27
| Facility | | $177.83 | $524.81 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $758.58
| Professional | | $316.23 | $398.11 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $331.13
| Facility | | $165.96 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $331.13
| Professional | | $114.82 | $165.96 | $331.13 |