- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $354.81 / $35,481.34
| Facility | | $199.53 | $354.81 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $281.84
| Professional | | $199.53 | $199.53 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $562.34
| Facility | | $213.80 | $275.42 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $275.42
| Professional | | $199.53 | $199.53 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $199.53 / $295.12
| Facility | | $190.55 | $199.53 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $229.09
| Professional | | $199.53 | $199.53 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $213.80 / $380.19
| Facility | | $194.98 | $213.80 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $199.53 / $229.09
| Professional | | $194.98 | $199.53 | $229.09 |