- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $616.60 / $977.24
| Facility | | $173.78 | $616.60 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $141.25 / $169.82
| Professional | | $104.71 | $141.25 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $501.19 / $851.14
| Facility | | $218.78 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $173.78
| Professional | | $74.13 | $74.13 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $114.82 / $537.03
| Facility | | $93.33 | $114.82 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $257.04
| Professional | | $213.80 | $213.80 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Professional | | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $173.78 / $173.78
| Professional | | $123.03 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $104.71
| Professional | | $74.13 | $74.13 | $104.71 |