- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.42 / $401.96 / $1,048.25
| Facility | | $202.42 | $401.96 | $1,048.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.71 / $218.06 / $223.31
| Professional | | $174.71 | $218.06 | $223.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.36 / $457.08 / $724.07
| Facility | | $120.36 | $457.08 | $724.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.16 / $221.34 / $1,072.09
| Professional | | $152.16 | $221.34 | $1,072.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.22 / $182.45 / $479.86
| Facility | | $144.22 | $182.45 | $479.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.02 / $262.72 / $515.33
| Facility | | $176.02 | $262.72 | $515.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.34 / $110.34 / $1,308.34
| Professional | | $110.34 | $110.34 | $1,308.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.34 / $110.34 / $157.63
| Professional | | $110.34 | $110.34 | $157.63 |