- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.71 / $280.42 / $997.64
| Facility | | $215.71 | $280.42 | $997.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.10 / $246.24 / $264.55
| Professional | | $122.10 | $246.24 | $264.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.70 / $391.07 / $654.16
| Facility | | $220.70 | $391.07 | $654.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.15 / $223.85 / $285.77
| Professional | | $183.15 | $223.85 | $285.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.50 / $203.50 / $203.50
| Facility | | $203.50 | $203.50 | $203.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.93 / $507.32 / $1,003.41
| Facility | | $212.93 | $507.32 | $1,003.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.72 / $210.82 / $421.30
| Professional | | $88.72 | $210.82 | $421.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.47 / $116.02 / $288.16
| Professional | | $85.47 | $116.02 | $288.16 |