- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.38 / $326.38 / $351.70
| Facility | | $326.38 | $326.38 | $351.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $119.58 / $119.58
| Professional | | $119.58 | $119.58 | $119.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.47 / $146.19 / $381.42
| Facility | | $116.47 | $146.19 | $381.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.57 / $119.57 / $119.57
| Professional | | $119.57 | $119.57 | $119.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.58 / $119.58 / $119.58
| Facility | | $119.58 | $119.58 | $119.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $119.58 / $119.58
| Professional | | $119.58 | $119.58 | $119.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $119.58 / $144.81
| Professional | | $119.58 | $119.58 | $144.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.38 / $326.38 / $351.70
| Facility | | $326.38 | $326.38 | $351.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $119.58 / $351.70
| Professional | | $119.58 | $119.58 | $351.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.24 / $117.24 / $175.86
| Professional | | $117.24 | $117.24 | $175.86 |