- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $501.19 / $588.84
| Facility | | $295.12 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $257.04 / $323.59
| Professional | | $199.53 | $257.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $478.63
| Professional | | $181.97 | $213.80 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $724.44
| Facility | | $389.05 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $1,445.44
| Facility | | $263.03 | $363.08 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $181.97 / $1,513.56
| Professional | | $125.89 | $181.97 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $302.00 / $363.08
| Facility | | $125.89 | $302.00 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $181.97 / $331.13
| Professional | | $125.89 | $181.97 | $331.13 |