- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.03 / $634.41 / $1,108.97
| Facility | | $229.03 | $634.41 | $1,108.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $229.03 / $283.27
| Professional | | $180.81 | $229.03 | $283.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.73 / $867.89 / $1,454.13
| Facility | | $385.73 | $867.89 | $1,454.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.56 / $126.56 / $301.35
| Professional | | $126.56 | $126.56 | $301.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.37 / $201.76 / $920.64
| Facility | | $172.37 | $201.76 | $920.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.08 / $369.08 / $436.96
| Professional | | $369.08 | $369.08 | $436.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.03 / $301.35 / $421.89
| Facility | | $229.03 | $301.35 | $421.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.08 / $421.89 / $602.70
| Professional | | $241.08 | $421.89 | $602.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $180.81
| Professional | | $126.57 | $126.57 | $180.81 |