- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $151.36 / $331.13
| Professional | | $147.91 | $151.36 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $245.47
| Facility | | $109.65 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $151.36
| Professional | | $123.03 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $154.88 / $190.55
| Facility | | $151.36 | $154.88 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $154.88 / $281.84
| Professional | | $147.91 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Professional | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $154.88
| Professional | | $151.36 | $151.36 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $177.83 / $186.21
| Professional | | $165.96 | $177.83 | $186.21 |