- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $354.81 / $616.60
| Facility | | $144.54 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $117.49 / $208.93
| Professional | | $91.20 | $117.49 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $1,174.90 / $1,258.93
| Facility | | $169.82 | $1,174.90 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $87.10 / $162.18
| Professional | | $57.54 | $87.10 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $331.13 / $331.13
| Facility | | $288.40 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $147.91 / $263.03
| Professional | | $77.62 | $147.91 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $316.23
| Professional | | $144.54 | $173.78 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $645.65
| Facility | | $144.54 | $144.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $144.54 / $457.09
| Professional | | $109.65 | $144.54 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $331.13
| Professional | | $144.54 | $173.78 | $331.13 |