- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.72 / $137.72 / $560.52
| Facility | | $137.72 | $137.72 | $560.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.31 / $132.46 / $180.12
| Professional | | $125.31 | $132.46 | $180.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.31 / $404.07 / $582.85
| Facility | | $221.31 | $404.07 | $582.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.40 / $318.97 / $407.20
| Professional | | $136.40 | $318.97 | $407.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.73 / $131.16 / $131.16
| Facility | | $123.73 | $131.16 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.72 / $165.26 / $392.50
| Facility | | $137.72 | $165.26 | $392.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.00 / $471.00 / $471.00
| Professional | | $471.00 | $471.00 | $471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $139.03 / $146.01
| Professional | | $131.16 | $139.03 | $146.01 |