- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,202.26 / $1,548.82
| Facility | | $218.78 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $218.78 / $309.03
| Professional | | $134.90 | $218.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $239.88 / $758.58
| Facility | | $234.42 | $239.88 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $1,288.25
| Facility | | $234.42 | $331.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $251.19 / $275.42
| Professional | | $234.42 | $251.19 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $794.33
| Professional | | $190.55 | $190.55 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $239.88 / $416.87
| Professional | | $218.78 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $165.96
| Professional | | $104.71 | $104.71 | $165.96 |