- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $870.96 / $1,380.38
| Facility | | $245.47 | $870.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $194.98 / $239.88
| Professional | | $162.18 | $194.98 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $707.95 / $1,202.26
| Facility | | $309.03 | $707.95 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $190.55
| Professional | | $104.71 | $104.71 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $162.18 / $758.58
| Facility | | $131.83 | $162.18 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $354.81
| Professional | | $169.82 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $181.97
| Professional | | $104.71 | $104.71 | $181.97 |