- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $407.38 / $407.38
| Facility | | $151.36 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $169.82 / $275.42
| Professional | | $123.03 | $169.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $181.97
| Facility | | $177.83 | $177.83 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $346.74
| Professional | | $128.82 | $128.82 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $1,479.11
| Facility | | $134.90 | $204.17 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $151.36 / $389.05
| Professional | | $93.33 | $151.36 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $323.59 / $323.59
| Facility | | $141.25 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $141.25 / $204.17
| Professional | | $93.33 | $141.25 | $204.17 |