- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $741.31
| Facility | | $245.47 | $354.81 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $162.18 / $239.88
| Professional | | $134.90 | $162.18 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $407.38 / $660.69
| Facility | | $309.03 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $125.89 / $190.55
| Professional | | $45.71 | $125.89 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $245.47 / $1,000.00
| Facility | | $162.18 | $245.47 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $354.81
| Professional | | $281.84 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $144.54
| Professional | | $114.82 | $114.82 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $436.52
| Professional | | $104.71 | $147.91 | $436.52 |