- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.02 / $198.02 / $221.71
| Facility | | $198.02 | $198.02 | $221.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.37 / $198.02 / $221.71
| Professional | | $145.37 | $198.02 | $221.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.38 / $4.38 / $7.25
| Professional | | $4.38 | $4.38 | $7.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.41 / $293.41 / $293.41
| Facility | | $293.41 | $293.41 | $293.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.38 / $216.38 / $216.38
| Professional | | $216.38 | $216.38 | $216.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.49 / $303.44 / $394.48
| Professional | | $250.49 | $303.44 | $394.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.02 / $227.49 / $362.38
| Facility | | $198.02 | $227.49 | $362.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $454.00 / $618.66
| Professional | | $304.00 | $454.00 | $618.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.02 / $307.18 / $566.08
| Facility | | $264.02 | $307.18 | $566.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.02 / $307.18 / $566.08
| Professional | | $264.02 | $307.18 | $566.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.57 / $254.57 / $267.30
| Professional | | $254.57 | $254.57 | $267.30 |