- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.47 / $207.31 / $497.54
| Facility | | $155.47 | $207.31 | $497.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.41 / $153.41 / $221.82
| Professional | | $153.41 | $153.41 | $221.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.68 / $1,387.68 / $1,387.68
| Facility | | $1,387.68 | $1,387.68 | $1,387.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.94 / $196.94 / $196.94
| Professional | | $196.94 | $196.94 | $196.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.75 / $134.75 / $553.82
| Facility | | $134.75 | $134.75 | $553.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.53 / $110.56 / $302.64
| Professional | | $86.53 | $110.56 | $302.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.41 / $207.31 / $348.28
| Facility | | $153.41 | $207.31 | $348.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $87.07 / $310.97
| Professional | | $87.07 | $87.07 | $310.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $87.07 / $132.68
| Professional | | $87.07 | $87.07 | $132.68 |