- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.15 / $476.92 / $715.38
| Facility | | $255.15 | $476.92 | $715.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.46 / $238.46 / $286.14
| Professional | | $210.46 | $238.46 | $286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.91 / $545.40 / $1,081.95
| Facility | | $138.91 | $545.40 | $1,081.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.08 / $195.39 / $248.95
| Professional | | $168.08 | $195.39 | $248.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $280.85
| Facility | | $238.46 | $238.46 | $280.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $238.46
| Professional | | $238.46 | $238.46 | $238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.30 / $210.11 / $3,359.87
| Facility | | $170.30 | $210.11 | $3,359.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.64 / $173.64 / $16,586.83
| Professional | | $173.64 | $173.64 | $16,586.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $252.77
| Professional | | $238.46 | $238.46 | $252.77 |