- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.72 / $178.72 / $264.20
| Facility | | $178.72 | $178.72 | $264.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.46 / $198.15 / $264.20
| Professional | | $166.46 | $198.15 | $264.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.14 / $340.14 / $340.14
| Professional | | $340.14 | $340.14 | $340.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.08 / $357.19 / $359.16
| Professional | | $295.08 | $357.19 | $359.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.83 / $340.48 / $629.64
| Facility | | $37.83 | $340.48 | $629.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.40 / $381.60 / $624.21
| Professional | | $45.40 | $381.60 | $624.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.78 / $243.78 / $512.41
| Facility | | $243.78 | $243.78 | $512.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.21 / $243.78 / $420.64
| Professional | | $207.21 | $243.78 | $420.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.36 / $100.00 / $253.65
| Professional | | $25.36 | $100.00 | $253.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.78 / $221.60 / $359.16
| Professional | | $134.78 | $221.60 | $359.16 |