- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.75 / $173.08 / $997.07
| Facility | | $140.75 | $173.08 | $997.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.75 / $140.75 / $173.08
| Professional | | $140.75 | $140.75 | $173.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.75 / $239.28 / $505.57
| Facility | | $140.75 | $239.28 | $505.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.37 / $166.48 / $166.48
| Professional | | $147.37 | $166.48 | $166.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.82 / $161.82 / $161.82
| Facility | | $161.82 | $161.82 | $161.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.82 / $161.82 / $161.82
| Professional | | $161.82 | $161.82 | $161.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.50 / $164.43 / $624.29
| Facility | | $108.50 | $164.43 | $624.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.47 / $173.08 / $174.73
| Professional | | $144.47 | $173.08 | $174.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.47 / $170.49 / $173.38
| Professional | | $144.47 | $170.49 | $173.38 |