- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $1,096.48
| Facility | | $251.19 | $354.81 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $426.58
| Professional | | $138.04 | $218.78 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $144.54 / $204.17
| Professional | | $128.82 | $144.54 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $446.68
| Facility | | $0.02 | $0.02 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $245.47 / $288.40
| Professional | | $199.53 | $245.47 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $147.91 / $165.96
| Facility | | $39.81 | $147.91 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $190.55 / $295.12
| Professional | | $120.23 | $190.55 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $263.03
| Professional | | $131.83 | $173.78 | $263.03 |