- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $954.99 / $1,548.82
| Facility | | $275.42 | $954.99 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $263.03
| Professional | | $151.36 | $208.93 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $794.33 / $1,318.26
| Facility | | $354.81 | $794.33 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $275.42
| Professional | | $114.82 | $114.82 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $177.83 / $831.76
| Facility | | $147.91 | $177.83 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $338.84 / $398.11
| Professional | | $331.13 | $338.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $275.42
| Professional | | $190.55 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $147.91
| Professional | | $104.71 | $104.71 | $147.91 |