- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.68 / $205.13 / $211.72
| Facility | | $138.68 | $205.13 | $211.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.68 / $158.91 / $288.92
| Professional | | $138.68 | $158.91 | $288.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.54 / $318.72 / $1,401.14
| Facility | | $303.54 | $318.72 | $1,401.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.88 / $164.70 / $249.69
| Professional | | $150.88 | $164.70 | $249.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.29 / $170.29 / $170.29
| Facility | | $170.29 | $170.29 | $170.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.75 / $144.75 / $175.40
| Professional | | $144.75 | $144.75 | $175.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.68 / $244.65 / $1,420.57
| Facility | | $138.68 | $244.65 | $1,420.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.30 / $162.27 / $269.50
| Professional | | $113.30 | $162.27 | $269.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.30 / $151.44 / $215.26
| Professional | | $113.30 | $151.44 | $215.26 |