- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.44 / $259.50 / $709.07
| Facility | | $219.44 | $259.50 | $709.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.19 / $219.44 / $494.87
| Professional | | $129.19 | $219.44 | $494.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,660.52 / $2,660.52 / $2,894.65
| Facility | | $2,660.52 | $2,660.52 | $2,894.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.07 / $230.38 / $255.98
| Professional | | $174.07 | $230.38 | $255.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.43 / $2,360.64 / $4,616.56
| Facility | | $221.43 | $2,360.64 | $4,616.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.38 / $303.43 / $833.53
| Professional | | $156.38 | $303.43 | $833.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,247.43 / $4,964.68 / $9,389.29
| Facility | | $3,247.43 | $4,964.68 | $9,389.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.81 / $265.58 / $644.16
| Professional | | $166.81 | $265.58 | $644.16 |