- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $524.81
| Facility | | $173.78 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $147.91 / $269.15
| Professional | | $120.23 | $147.91 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $281.84 / $2,290.87
| Facility | | $208.93 | $281.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $371.54 / $812.83
| Facility | | $114.82 | $371.54 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $204.17 / $295.12
| Professional | | $79.43 | $204.17 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $316.23
| Professional | | $131.83 | $208.93 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $229.09
| Professional | | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $354.81
| Facility | | $173.78 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $104.71 / $177.83
| Professional | | $74.13 | $104.71 | $177.83 |