- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.73 / $423.74 / $562.64
| Facility | | $238.73 | $423.74 | $562.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.83 / $198.94 / $1,639.97
| Professional | | $142.83 | $198.94 | $1,639.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.55 / $255.05 / $318.81
| Facility | | $113.55 | $255.05 | $318.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.02 / $102.02 / $200.00
| Professional | | $102.02 | $102.02 | $200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.78 / $298.39 / $923.39
| Facility | | $165.78 | $298.39 | $923.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.65 / $310.39 / $371.88
| Professional | | $129.65 | $310.39 | $371.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.23 / $260.26 / $260.26
| Professional | | $234.23 | $260.26 | $260.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.26 / $260.26 / $260.26
| Professional | | $260.26 | $260.26 | $260.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.80 / $107.12 / $260.26
| Professional | | $83.80 | $107.12 | $260.26 |