- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.83 / $165.84 / $807.58
| Facility | | $134.83 | $165.84 | $807.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.83 / $134.83 / $174.48
| Professional | | $134.83 | $134.83 | $174.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.05 / $164.35 / $173.00
| Facility | | $147.05 | $164.35 | $173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.62 / $158.62 / $158.62
| Professional | | $158.62 | $158.62 | $158.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Facility | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $148.32 / $148.32
| Professional | | $110.00 | $148.32 | $148.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.87 / $145.38 / $165.84
| Facility | | $96.87 | $145.38 | $165.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.44 / $156.27 / $158.91
| Professional | | $141.44 | $156.27 | $158.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.44 / $156.27 / $178.56
| Professional | | $141.44 | $156.27 | $178.56 |