- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.46 / $480.72 / $8,268.26
| Facility | | $150.46 | $480.72 | $8,268.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.46 / $269.45 / $655.86
| Professional | | $150.46 | $269.45 | $655.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.93 / $153.93 / $190.49
| Facility | | $153.93 | $153.93 | $190.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.32 / $169.32 / $169.32
| Professional | | $169.32 | $169.32 | $169.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.82 / $246.82 / $246.82
| Facility | | $246.82 | $246.82 | $246.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.54 / $432.14 / $1,315.18
| Professional | | $197.54 | $432.14 | $1,315.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,077.16 / $2,077.16 / $2,077.16
| Facility | | $2,077.16 | $2,077.16 | $2,077.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.94 / $708.64 / $1,191.25
| Professional | | $404.94 | $708.64 | $1,191.25 |