- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.52 / $186.60 / $389.81
| Facility | | $142.52 | $186.60 | $389.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.81 / $149.59 / $298.64
| Professional | | $122.81 | $149.59 | $298.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.04 / $560.50 / $733.28
| Facility | | $332.04 | $560.50 | $733.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.04 / $209.91 / $509.29
| Professional | | $145.04 | $209.91 | $509.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.85 / $660.09 / $6,311.04
| Facility | | $195.85 | $660.09 | $6,311.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.87 / $276.89 / $604.03
| Professional | | $140.87 | $276.89 | $604.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,890.28 / $4,677.81 / $6,438.74
| Facility | | $2,890.28 | $4,677.81 | $6,438.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.57 / $226.03 / $497.36
| Professional | | $152.57 | $226.03 | $497.36 |