- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.43 / $405.10 / $1,096.57
| Facility | | $250.43 | $405.10 | $1,096.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.76 / $206.12 / $233.61
| Professional | | $182.76 | $206.12 | $233.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $541.66 / $858.06
| Facility | | $142.63 | $541.66 | $858.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.33 / $262.30 / $1,270.50
| Professional | | $180.33 | $262.30 | $1,270.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.59 / $446.60 / $803.88
| Facility | | $183.59 | $446.60 | $803.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.14 / $274.83 / $505.84
| Facility | | $184.14 | $274.83 | $505.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $115.43 / $1,368.65
| Professional | | $115.43 | $115.43 | $1,368.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $115.43 / $164.90
| Professional | | $115.43 | $115.43 | $164.90 |