- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.86 / $219.40 / $607.29
| Facility | | $135.86 | $219.40 | $607.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.86 / $157.13 / $186.57
| Professional | | $135.86 | $157.13 | $186.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.47 / $181.37 / $626.22
| Facility | | $131.47 | $181.37 | $626.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.34 / $54.34 / $140.77
| Professional | | $54.34 | $54.34 | $140.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.00 / $216.35 / $289.79
| Facility | | $210.00 | $216.35 | $289.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.49 / $165.62 / $196.83
| Professional | | $137.49 | $165.62 | $196.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.86 / $135.86 / $164.53
| Professional | | $135.86 | $135.86 | $164.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.86 / $208.89 / $607.29
| Facility | | $135.86 | $208.89 | $607.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.86 / $135.86 / $186.57
| Professional | | $135.86 | $135.86 | $186.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.52 / $99.47 / $240.40
| Professional | | $81.52 | $99.47 | $240.40 |