- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.44 / $1,286.10 / $1,686.17
| Facility | | $245.44 | $1,286.10 | $1,686.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.44 / $245.44 / $245.44
| Professional | | $245.44 | $245.44 | $245.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.36 / $242.07 / $758.70
| Facility | | $235.36 | $242.07 | $758.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.42 / $330.42 / $330.42
| Professional | | $330.42 | $330.42 | $330.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $60.00
| Professional | | $45.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.35 / $316.64 / $330.42
| Facility | | $275.35 | $316.64 | $330.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.42 / $285.07 / $382.11
| Professional | | $250.42 | $285.07 | $382.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.65 / $115.65 / $165.21
| Professional | | $115.65 | $115.65 | $165.21 |