- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.43 / $328.40 / $394.08
| Facility | | $215.43 | $328.40 | $394.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.04 / $215.43 / $223.31
| Professional | | $197.04 | $215.43 | $223.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.67 / $1,477.80 / $7,093.44
| Facility | | $354.67 | $1,477.80 | $7,093.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.26 / $354.67 / $119,998.80
| Professional | | $315.26 | $354.67 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.46 / $256.16 / $315.26
| Facility | | $213.46 | $256.16 | $315.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.31 / $1,266.31 / $1,266.31
| Professional | | $1,266.31 | $1,266.31 | $1,266.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.34 / $131.36 / $380.94
| Professional | | $110.34 | $131.36 | $380.94 |