- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,650.78 / $8,042.76
| Facility | | $199.53 | $1,650.78 | $8,042.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.19 / $199.53 / $324.01
| Professional | | $168.19 | $199.53 | $324.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.08 / $265.12 / $391.05
| Professional | | $212.08 | $265.12 | $391.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.69 / $299.30 / $444.42
| Professional | | $239.69 | $299.30 | $444.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.36 / $292.83 / $449.21
| Professional | | $227.36 | $292.83 | $449.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,729.38 / $10,210.45
| Facility | | $199.53 | $1,729.38 | $10,210.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.94 / $199.53 / $378.78
| Professional | | $197.94 | $199.53 | $378.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.63 / $285.79 / $408.96
| Professional | | $191.63 | $285.79 | $408.96 |