- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $131.83 / $275.42
| Facility | | $83.18 | $131.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $114.82 / $218.78
| Professional | | $75.86 | $114.82 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $9,549.93
| Facility | | $1,698.24 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $117.49 / $218.78
| Professional | | $77.62 | $117.49 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $154.88 / $912.01
| Facility | | $70.79 | $154.88 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $147.91 / $309.03
| Professional | | $89.13 | $147.91 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,467.37
| Facility | | $223.87 | $1,071.52 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $120.23 / $223.87
| Professional | | $75.86 | $120.23 | $223.87 |