- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.03 / $130.03 / $585.14
| Facility | | $130.03 | $130.03 | $585.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.80 / $130.03 / $278.85
| Professional | | $83.80 | $130.03 | $278.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.03
| Facility | | $0.02 | $0.02 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.84 / $2,764.80 / $3,732.48
| Professional | | $400.84 | $2,764.80 | $3,732.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.63 / $181.44 / $209.36
| Facility | | $118.63 | $181.44 | $209.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.57 / $160.51 / $209.36
| Professional | | $139.57 | $160.51 | $209.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.69 / $128.69 / $128.69
| Facility | | $128.69 | $128.69 | $128.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.69 / $128.69 / $131.51
| Professional | | $128.69 | $128.69 | $131.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.31 / $259.31 / $346.39
| Professional | | $259.31 | $259.31 | $346.39 |