- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.66 / $134.19 / $840.70
| Facility | | $130.66 | $134.19 | $840.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.19 / $134.19 / $158.10
| Professional | | $134.19 | $134.19 | $158.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.27 / $235.61 / $429.41
| Facility | | $146.27 | $235.61 | $429.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.19 / $134.19 / $134.19
| Professional | | $134.19 | $134.19 | $134.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.60 / $126.60 / $195.98
| Facility | | $126.60 | $126.60 | $195.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.04 / $177.04 / $177.04
| Professional | | $177.04 | $177.04 | $177.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.66 / $163.35 / $196.77
| Facility | | $130.66 | $163.35 | $196.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.64 / $147.61 / $220.07
| Professional | | $100.64 | $147.61 | $220.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.19 / $161.03 / $195.02
| Professional | | $134.19 | $161.03 | $195.02 |