- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.44 / $209.21 / $215.92
| Facility | | $141.44 | $209.21 | $215.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.44 / $162.06 / $294.66
| Professional | | $141.44 | $162.06 | $294.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.58 / $325.06 / $1,429.02
| Facility | | $309.58 | $325.06 | $1,429.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.82 / $186.03 / $250.46
| Professional | | $157.82 | $186.03 | $250.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.02 / $197.02 / $197.02
| Facility | | $197.02 | $197.02 | $197.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.82 / $143.82 / $202.93
| Professional | | $143.82 | $143.82 | $202.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.44 / $249.51 / $1,592.80
| Facility | | $141.44 | $249.51 | $1,592.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.14 / $167.32 / $324.89
| Professional | | $127.14 | $167.32 | $324.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.63 / $136.63 / $136.63
| Facility | | $136.63 | $136.63 | $136.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.14 / $155.62 / $235.11
| Professional | | $127.14 | $155.62 | $235.11 |