- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.88 / $367.65 / $1,157.18
| Facility | | $195.88 | $367.65 | $1,157.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $201.90 / $271.22
| Professional | | $180.81 | $201.90 | $271.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.37 / $231.52 / $1,132.72
| Facility | | $165.37 | $231.52 | $1,132.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.09 / $243.92 / $511.54
| Professional | | $145.09 | $243.92 | $511.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $180.81 / $263.39
| Professional | | $180.81 | $180.81 | $263.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.46 / $198.89 / $271.21
| Professional | | $193.46 | $198.89 | $271.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.35 / $301.35 / $452.02
| Facility | | $301.35 | $301.35 | $452.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.47 / $126.57 / $405.62
| Professional | | $105.47 | $126.57 | $405.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.35 / $301.35 / $301.35
| Professional | | $301.35 | $301.35 | $301.35 |