- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $181.97 / $524.81
| Facility | | $177.83 | $181.97 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $181.97 / $218.78
| Professional | | $173.78 | $181.97 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.14 / $2.24 / $186.21
| Facility | | $2.14 | $2.24 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $18.62
| Facility | | $13.80 | $13.80 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $190.55
| Professional | | $181.97 | $181.97 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Professional | | $181.97 | $181.97 | $181.97 |