- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.89 / $133.24 / $678.73
| Facility | | $101.89 | $133.24 | $678.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.43 / $109.73 / $141.08
| Professional | | $85.43 | $109.73 | $141.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.75 / $110.25 / $589.96
| Facility | | $78.75 | $110.25 | $589.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.31 / $191.31 / $229.21
| Professional | | $191.31 | $191.31 | $229.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.05 / $94.05 / $133.24
| Professional | | $94.05 | $94.05 | $133.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $70.00
| Professional | | $40.00 | $40.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.75 / $156.75 / $156.75
| Facility | | $156.75 | $156.75 | $156.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.86 / $65.84 / $245.61
| Professional | | $54.86 | $65.84 | $245.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.05 / $94.05 / $94.05
| Professional | | $94.05 | $94.05 | $94.05 |