- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,318.26 / $1,949.84
| Facility | | $371.54 | $1,318.26 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $446.68
| Professional | | $316.23 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $6.17 / $6.17
| Professional | | $3.39 | $6.17 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $446.68 / $2,754.23
| Facility | | $316.23 | $446.68 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $870.96
| Facility | | $316.23 | $316.23 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $70.79
| Professional | | $50.12 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,230.27
| Facility | | $933.25 | $933.25 | $1,230.27 |