- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $245.47 / $575.44
| Facility | | $181.97 | $245.47 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $151.36
| Professional | | $102.33 | $128.82 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $467.74
| Facility | | $158.49 | $158.49 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.89 / $12.30
| Professional | | $5.01 | $5.89 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,290.87 / $3,388.44
| Facility | | $151.36 | $2,290.87 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $616.60
| Facility | | $102.33 | $102.33 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $190.55 / $467.74
| Professional | | $7.76 | $190.55 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $93.33 / $158.49
| Professional | | $66.07 | $93.33 | $158.49 |