- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.31 / $234.36 / $643.74
| Facility | | $93.31 | $234.36 | $643.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.09 / $139.53 / $254.23
| Professional | | $113.09 | $139.53 | $254.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.76 / $108.76 / $264.64
| Professional | | $108.76 | $108.76 | $264.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.48 / $173.35 / $298.98
| Professional | | $114.48 | $173.35 | $298.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.37 / $325.43 / $440.36
| Facility | | $218.37 | $325.43 | $440.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.45 / $167.77 / $305.82
| Professional | | $93.45 | $167.77 | $305.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.26 / $823.22 / $823.22
| Facility | | $309.26 | $823.22 | $823.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.11 / $1,029.11 / $1,288.43
| Professional | | $1,029.11 | $1,029.11 | $1,288.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.83 / $165.29 / $296.77
| Professional | | $103.83 | $165.29 | $296.77 |