- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.44 / $1,432.83 / $1,878.53
| Facility | | $273.44 | $1,432.83 | $1,878.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.44 / $273.44 / $273.44
| Professional | | $273.44 | $273.44 | $273.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.05 / $226.32 / $709.35
| Facility | | $220.05 | $226.32 | $709.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.06 / $307.30 / $486.18
| Professional | | $162.06 | $307.30 | $486.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $296.07 / $1,158.50
| Facility | | $257.45 | $296.07 | $1,158.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.58 / $313.50 / $394.57
| Professional | | $277.58 | $313.50 | $394.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $148.63 / $154.47
| Professional | | $108.13 | $148.63 | $154.47 |