- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $478.63 / $5,623.41
| Facility | | $154.88 | $478.63 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $186.21 / $316.23
| Professional | | $154.88 | $186.21 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $354.81
| Professional | | $234.42 | $234.42 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $223.87 / $1,122.02
| Facility | | $154.88 | $223.87 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $204.17 / $478.63
| Professional | | $102.33 | $204.17 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $371.54
| Facility | | $128.82 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $162.18 / $234.42
| Professional | | $102.33 | $162.18 | $234.42 |