- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $226.35 / $391.11
| Facility | | $142.63 | $226.35 | $391.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.62 / $142.63 / $195.87
| Professional | | $142.62 | $142.63 | $195.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.66 / $203.83 / $378.69
| Facility | | $120.66 | $203.83 | $378.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.73 / $140.11 / $230.68
| Professional | | $72.73 | $140.11 | $230.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $148.26 / $530.96
| Facility | | $142.63 | $148.26 | $530.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.94 / $175.68 / $316.05
| Professional | | $100.94 | $175.68 | $316.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.02 / $146.08 / $195.47
| Professional | | $120.02 | $146.08 | $195.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.77 / $262.60 / $316.55
| Facility | | $260.77 | $262.60 | $316.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.61 / $109.12 / $229.60
| Professional | | $65.61 | $109.12 | $229.60 |