- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.35 / $240.84 / $354.26
| Facility | | $136.35 | $240.84 | $354.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.57 / $110.86 / $136.35
| Professional | | $95.57 | $110.86 | $136.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.02 / $293.45 / $440.19
| Facility | | $276.02 | $293.45 | $440.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.71 / $202.71 / $202.71
| Professional | | $202.71 | $202.71 | $202.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.62 / $239.88 / $637.10
| Facility | | $103.62 | $239.88 | $637.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.81 / $183.08 / $242.51
| Professional | | $70.81 | $183.08 | $242.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.49 / $151.69 / $221.73
| Facility | | $104.49 | $151.69 | $221.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.52 / $91.16 / $637.15
| Professional | | $53.52 | $91.16 | $637.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.52 / $76.45 / $203.89
| Professional | | $53.52 | $76.45 | $203.89 |