- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.46 / $206.10 / $338.72
| Facility | | $132.46 | $206.10 | $338.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.46 / $206.10 / $332.26
| Professional | | $132.46 | $206.10 | $332.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.33 / $163.16 / $177.77
| Facility | | $146.33 | $163.16 | $177.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.44 / $158.02 / $158.02
| Professional | | $130.44 | $158.02 | $158.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.64 / $234.64 / $234.64
| Facility | | $234.64 | $234.64 | $234.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.26 / $242.97 / $598.35
| Professional | | $137.26 | $242.97 | $598.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.30 / $231.13 / $338.72
| Professional | | $157.30 | $231.13 | $338.72 |