- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.35 / $307.70 / $408.56
| Facility | | $173.35 | $307.70 | $408.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.71 / $144.46 / $1,190.83
| Professional | | $103.71 | $144.46 | $1,190.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.45 / $185.20 / $231.50
| Facility | | $82.45 | $185.20 | $231.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.08 / $74.08 / $163.72
| Professional | | $74.08 | $74.08 | $163.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.38 / $216.68 / $670.52
| Facility | | $120.38 | $216.68 | $670.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.55 / $108.34 / $270.64
| Professional | | $92.55 | $108.34 | $270.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.30 / $46.30 / $190.00
| Professional | | $46.30 | $46.30 | $190.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.30 / $46.30 / $46.30
| Professional | | $46.30 | $46.30 | $46.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.78 / $77.78 / $240.76
| Professional | | $77.78 | $77.78 | $240.76 |