- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.47 / $377.06 / $1,180.14
| Facility | | $230.47 | $377.06 | $1,180.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.47 / $232.20 / $244.88
| Professional | | $230.47 | $232.20 | $244.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.60 / $340.84 / $957.02
| Facility | | $176.60 | $340.84 | $957.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.60 / $176.60 / $250.77
| Professional | | $176.60 | $176.60 | $250.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.02 / $202.88 / $310.41
| Facility | | $34.02 | $202.88 | $310.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.49 / $230.70 / $290.04
| Professional | | $35.49 | $230.70 | $290.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.28 / $483.33 / $852.82
| Facility | | $209.28 | $483.33 | $852.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.95 / $284.85 / $570.69
| Professional | | $193.95 | $284.85 | $570.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.09 / $297.54 / $498.60
| Professional | | $238.09 | $297.54 | $498.60 |