- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.45 / $1,228.52 / $1,610.67
| Facility | | $234.45 | $1,228.52 | $1,610.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.28 / $208.40 / $276.13
| Professional | | $171.28 | $208.40 | $276.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.67 / $229.02 / $717.79
| Facility | | $222.67 | $229.02 | $717.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.22 / $299.43 / $476.88
| Professional | | $247.22 | $299.43 | $476.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.50 / $299.58 / $1,055.03
| Facility | | $260.50 | $299.58 | $1,055.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.56 / $281.18 / $312.42
| Professional | | $221.56 | $281.18 | $312.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.41 / $109.41 / $156.30
| Professional | | $109.41 | $109.41 | $156.30 |