- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.80 / $685.77 / $9,372.46
| Facility | | $207.80 | $685.77 | $9,372.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.56 / $468.81 / $685.77
| Professional | | $266.56 | $468.81 | $685.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.02 / $232.96 / $328.74
| Professional | | $198.02 | $232.96 | $328.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.09 / $378.93 / $657.08
| Professional | | $226.09 | $378.93 | $657.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.34 / $356.55 / $584.08
| Professional | | $214.34 | $356.55 | $584.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.80 / $2,163.48 / $9,372.46
| Facility | | $207.80 | $2,163.48 | $9,372.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.20 / $468.81 / $685.77
| Professional | | $261.20 | $468.81 | $685.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.02 / $704.59 / $913.36
| Professional | | $443.02 | $704.59 | $913.36 |