- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.48 / $938.20 / $2,055.60
| Facility | | $277.48 | $938.20 | $2,055.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.74 / $140.13 / $208.11
| Professional | | $138.74 | $140.13 | $208.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.97 / $259.80 / $642.49
| Facility | | $109.97 | $259.80 | $642.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.69 / $137.46 / $324.76
| Professional | | $111.69 | $137.46 | $324.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.41 / $138.74 / $138.74
| Facility | | $135.41 | $138.74 | $138.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.74 / $138.74 / $138.74
| Professional | | $138.74 | $138.74 | $138.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.77 / $164.77 / $301.72
| Facility | | $132.77 | $164.77 | $301.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.18 / $136.18 / $295.51
| Professional | | $136.18 | $136.18 | $295.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.74 / $138.74 / $138.74
| Professional | | $138.74 | $138.74 | $138.74 |