- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $436.52 / $436.52
| Facility | | $380.19 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $371.54 / $602.56
| Professional | | $354.81 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $6.76 / $8.51
| Professional | | $6.76 | $6.76 | $8.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $501.19 / $1,096.48
| Facility | | $8.13 | $501.19 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $371.54 / $371.54
| Professional | | $6.76 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $11.48 / $11.48
| Professional | | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $371.54 / $407.38
| Professional | | $151.36 | $371.54 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |