- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.17 / $183.17 / $232.47
| Facility | | $183.17 | $183.17 | $232.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.17 / $211.34 / $270.52
| Professional | | $183.17 | $211.34 | $270.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.97 / $146.97 / $228.05
| Professional | | $146.97 | $146.97 | $228.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.20 / $232.20 / $232.20
| Facility | | $232.20 | $232.20 | $232.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.20 / $232.20 / $248.63
| Professional | | $232.20 | $232.20 | $248.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.17 / $194.16 / $273.49
| Facility | | $183.17 | $194.16 | $273.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.81 / $131.81 / $131.81
| Professional | | $131.81 | $131.81 | $131.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.33 / $303.33 / $410.24
| Facility | | $303.33 | $303.33 | $410.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.32 / $238.42 / $248.63
| Professional | | $207.32 | $238.42 | $248.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.20 / $236.20 / $613.50
| Facility | | $236.20 | $236.20 | $613.50 |