- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,288.25 / $3,715.35
| Facility | | $446.68 | $1,288.25 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $131.83 / $575.44
| Professional | | $52.48 | $131.83 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $758.58 / $1,348.96
| Facility | | $446.68 | $758.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $109.65 / $630.96
| Professional | | $61.66 | $109.65 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $457.09 / $457.09
| Facility | | $39.81 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $165.96 / $575.44
| Professional | | $57.54 | $165.96 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,047.13 / $2,187.76
| Facility | | $338.84 | $1,047.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $281.84 / $575.44
| Professional | | $50.12 | $281.84 | $575.44 |