- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.47 / $184.32 / $377.87
| Facility | | $133.47 | $184.32 | $377.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.47 / $133.47 / $133.47
| Professional | | $133.47 | $133.47 | $133.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.51 / $201.21 / $400.08
| Facility | | $124.51 | $201.21 | $400.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.12 / $120.12 / $120.12
| Professional | | $120.12 | $120.12 | $120.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.13 / $131.13 / $131.13
| Facility | | $131.13 | $131.13 | $131.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.13 / $131.13 / $131.13
| Professional | | $131.13 | $131.13 | $131.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.45 / $126.45 / $126.45
| Facility | | $126.45 | $126.45 | $126.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.45 / $154.55 / $186.30
| Professional | | $126.45 | $154.55 | $186.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $117.08 / $129.26
| Professional | | $117.08 | $117.08 | $129.26 |