- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $173.78 / $354.81
| Facility | | $162.18 | $173.78 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $218.78
| Professional | | $162.18 | $162.18 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $229.09 / $407.38
| Facility | | $186.21 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $186.21 / $263.03
| Professional | | $173.78 | $186.21 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $204.17 / $234.42
| Facility | | $154.88 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $204.17 / $213.80
| Professional | | $165.96 | $204.17 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $194.98 / $309.03
| Facility | | $186.21 | $194.98 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $194.98 / $218.78
| Professional | | $162.18 | $194.98 | $218.78 |