- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.65 / $329.51 / $1,266.83
| Facility | | $216.65 | $329.51 | $1,266.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.64 / $216.65 / $245.44
| Professional | | $174.64 | $216.65 | $245.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.06 / $386.28 / $794.05
| Facility | | $275.06 | $386.28 | $794.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.05 / $312.24 / $631.02
| Professional | | $168.05 | $312.24 | $631.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.41 / $1,059.83 / $1,890.69
| Facility | | $492.41 | $1,059.83 | $1,890.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.31 / $312.68 / $684.30
| Professional | | $187.31 | $312.68 | $684.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.66 / $438.91 / $626.07
| Professional | | $230.66 | $438.91 | $626.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $197.71 / $578.26
| Professional | | $138.38 | $197.71 | $578.26 |