- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.45 / $239.86 / $239.86
| Facility | | $228.45 | $239.86 | $239.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.86 / $239.86 / $263.83
| Professional | | $239.86 | $239.86 | $263.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.62 / $269.39 / $277.49
| Facility | | $258.62 | $269.39 | $277.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.18 / $228.45 / $228.45
| Professional | | $194.18 | $228.45 | $228.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.84 / $61.84 / $111.31
| Facility | | $61.84 | $61.84 | $111.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.78 / $61.84 / $95.23
| Professional | | $60.78 | $61.84 | $95.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.45 / $263.38 / $263.38
| Facility | | $228.45 | $263.38 | $263.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.06 / $263.38 / $313.13
| Professional | | $75.06 | $263.38 | $313.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.16 / $270.43 / $282.19
| Professional | | $235.16 | $270.43 | $282.19 |