- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $524.81
| Facility | | $416.87 | $416.87 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $524.81 / $1,380.38
| Professional | | $467.74 | $524.81 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $120.23 / $162.18
| Facility | | $100.00 | $120.23 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $309.03
| Professional | | $245.47 | $245.47 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $660.69 / $1,258.93
| Facility | | $39.81 | $660.69 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $138.04
| Professional | | $109.65 | $109.65 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $562.34 / $933.25
| Facility | | $21.38 | $562.34 | $933.25 |