- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,412.54
| Facility | | $213.80 | $549.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $263.03
| Professional | | $162.18 | $208.93 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $562.34 / $831.76
| Facility | | $173.78 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $269.15 / $524.81
| Professional | | $263.03 | $269.15 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $776.25
| Facility | | $147.91 | $190.55 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $501.19
| Facility | | $186.21 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $1,380.38
| Professional | | $104.71 | $104.71 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $331.13
| Facility | | $245.47 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $147.91
| Professional | | $104.71 | $104.71 | $147.91 |