- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $259.55 / $605.32
| Facility | | $142.63 | $259.55 | $605.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.53 / $146.36 / $213.94
| Professional | | $115.53 | $146.36 | $213.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.02 / $209.67 / $745.11
| Facility | | $138.02 | $209.67 | $745.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.57 / $85.58 / $103.10
| Professional | | $85.57 | $85.58 | $103.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.23 / $304.23 / $304.23
| Facility | | $304.23 | $304.23 | $304.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.30 / $144.36 / $231.25
| Professional | | $90.30 | $144.36 | $231.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $142.63 / $144.06
| Professional | | $142.63 | $142.63 | $144.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $265.98 / $605.32
| Facility | | $142.63 | $265.98 | $605.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.53 / $142.63 / $249.60
| Professional | | $115.53 | $142.63 | $249.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.92 / $85.58 / $180.60
| Professional | | $61.92 | $85.58 | $180.60 |