- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.68 / $513.52 / $793.49
| Facility | | $302.68 | $513.52 | $793.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.38 / $265.91 / $265.91
| Professional | | $186.38 | $265.91 | $265.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.48 / $253.48 / $253.48
| Professional | | $253.48 | $253.48 | $253.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.68 / $407.06 / $563.23
| Facility | | $219.68 | $407.06 | $563.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.81 / $248.51 / $334.33
| Facility | | $198.81 | $248.51 | $334.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.37 / $149.11 / $1,242.55
| Professional | | $104.37 | $149.11 | $1,242.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.40 / $683.40 / $683.40
| Facility | | $683.40 | $683.40 | $683.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.37 / $149.11 / $517.10
| Professional | | $104.37 | $149.11 | $517.10 |