- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $467.74 / $1,202.26
| Facility | | $223.87 | $467.74 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $831.76
| Professional | | $138.04 | $234.42 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $1,202.26
| Facility | | $251.19 | $354.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $117.49 / $416.87
| Professional | | $107.15 | $117.49 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.18 / $524.81 / $1,148.15
| Facility | | $13.18 | $524.81 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $338.84 / $676.08
| Professional | | $128.82 | $338.84 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $281.84 / $331.13
| Facility | | $117.49 | $281.84 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $117.49 / $281.84
| Professional | | $63.10 | $117.49 | $281.84 |