- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.34 / $207.04 / $214.54
| Facility | | $186.34 | $207.04 | $214.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.34 / $207.04 / $219.11
| Professional | | $186.34 | $207.04 | $219.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.66 / $202.92 / $305.63
| Professional | | $177.66 | $202.92 | $305.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.38 / $200.04 / $307.64
| Facility | | $34.38 | $200.04 | $307.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.49 / $49.45 / $296.11
| Professional | | $32.49 | $49.45 | $296.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.36 / $253.14 / $739.96
| Facility | | $176.36 | $253.14 | $739.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.42 / $342.57 / $1,041.46
| Professional | | $219.42 | $342.57 | $1,041.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $211.51
| Professional | | $32.34 | $32.34 | $211.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.68 / $247.57 / $307.94
| Professional | | $187.68 | $247.57 | $307.94 |