- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $354.81 / $1,380.38
| Facility | | $79.43 | $354.81 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $83.18 / $245.47
| Professional | | $60.26 | $83.18 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,258.93 / $1,737.80
| Facility | | $436.52 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $131.83 / $323.59
| Professional | | $89.13 | $131.83 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $316.23
| Facility | | $128.82 | $223.87 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $269.15 / $457.09
| Professional | | $169.82 | $269.15 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $426.58
| Professional | | $104.71 | $151.36 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $446.68
| Facility | | $102.33 | $102.33 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $131.83 / $281.84
| Professional | | $83.18 | $131.83 | $281.84 |