- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.97 / $427.73 / $567.92
| Facility | | $240.97 | $427.73 | $567.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.16 / $200.81 / $1,655.40
| Professional | | $144.16 | $200.81 | $1,655.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.62 / $257.45 / $321.81
| Facility | | $114.62 | $257.45 | $321.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.14 / $127.14 / $289.83
| Professional | | $127.14 | $127.14 | $289.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.34 / $301.20 / $932.08
| Facility | | $167.34 | $301.20 | $932.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.18 / $205.94 / $375.55
| Professional | | $187.18 | $205.94 | $375.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.47 / $88.47 / $257.45
| Professional | | $88.47 | $88.47 | $257.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.47 / $88.47 / $88.47
| Professional | | $88.47 | $88.47 | $88.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $148.63 / $491.00
| Professional | | $108.13 | $148.63 | $491.00 |