- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.18 / $193.54 / $705.48
| Facility | | $142.18 | $193.54 | $705.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.48 / $159.61 / $174.37
| Professional | | $80.48 | $159.61 | $174.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.41 / $239.86 / $337.16
| Facility | | $140.41 | $239.86 | $337.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.13 / $134.13 / $134.13
| Facility | | $134.13 | $134.13 | $134.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.18 / $947.77 / $1,018.83
| Facility | | $87.18 | $947.77 | $1,018.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.29 / $80.48 / $134.13
| Facility | | $48.29 | $80.48 | $134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $76.47 / $174.37
| Professional | | $56.33 | $76.47 | $174.37 |