- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.41 / $340.96 / $684.51
| Facility | | $182.41 | $340.96 | $684.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.77 / $202.14 / $1,124.66
| Professional | | $183.77 | $202.14 | $1,124.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.55 / $726.71 / $2,488.25
| Facility | | $158.55 | $726.71 | $2,488.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.18 / $161.71 / $1,084.48
| Professional | | $111.18 | $161.71 | $1,084.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.48 / $170.48 / $170.48
| Facility | | $170.48 | $170.48 | $170.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.48 / $170.48 / $170.48
| Professional | | $170.48 | $170.48 | $170.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.15 / $220.52 / $650.26
| Facility | | $22.15 | $220.52 | $650.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.06 / $167.06 / $167.06
| Professional | | $167.06 | $167.06 | $167.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.48 / $170.48 / $170.48
| Professional | | $170.48 | $170.48 | $170.48 |