- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.35 / $246.92 / $740.76
| Facility | | $162.35 | $246.92 | $740.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.35 / $162.35 / $172.84
| Professional | | $162.35 | $162.35 | $172.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.60 / $318.35 / $611.13
| Facility | | $52.60 | $318.35 | $611.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.77 / $125.92 / $170.37
| Professional | | $45.77 | $125.92 | $170.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.29 / $308.58 / $1,123.89
| Facility | | $162.29 | $308.58 | $1,123.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.73 / $283.73 / $354.66
| Professional | | $283.73 | $283.73 | $354.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.58 / $113.58 / $145.68
| Professional | | $113.58 | $113.58 | $145.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.71 / $148.15 / $515.55
| Professional | | $103.71 | $148.15 | $515.55 |