- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $281.84 / $1,122.02
| Facility | | $213.80 | $281.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $229.09 / $275.42
| Professional | | $190.55 | $229.09 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $575.44 / $2,187.76
| Facility | | $380.19 | $575.44 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $269.15 / $588.84
| Professional | | $151.36 | $269.15 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $269.15 / $912.01
| Facility | | $169.82 | $269.15 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $501.19
| Professional | | $165.96 | $251.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $380.19
| Facility | | $181.97 | $234.42 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $407.38
| Professional | | $177.83 | $234.42 | $407.38 |