- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.54 / $258.95 / $14,588.64
| Facility | | $138.54 | $258.95 | $14,588.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.71 / $156.79 / $320.70
| Professional | | $134.71 | $156.79 | $320.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.82 / $448.05 / $737.31
| Facility | | $112.82 | $448.05 | $737.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.23 / $125.43 / $823.67
| Professional | | $86.23 | $125.43 | $823.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.62 / $129.47 / $129.47
| Facility | | $124.62 | $129.47 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.58 / $172.26 / $356.33
| Facility | | $129.58 | $172.26 | $356.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.58 / $129.58 / $129.58
| Professional | | $129.58 | $129.58 | $129.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |