- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $537.03
| Facility | | $263.03 | $457.09 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $234.42 / $295.12
| Professional | | $173.78 | $234.42 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $169.82 / $436.52
| Professional | | $154.88 | $169.82 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $660.69
| Facility | | $354.81 | $524.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $331.13 / $1,318.26
| Facility | | $239.88 | $331.13 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $1,380.38
| Professional | | $104.71 | $147.91 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $275.42 / $331.13
| Facility | | $104.71 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $275.42
| Professional | | $104.71 | $147.91 | $275.42 |