- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.47 / $257.86 / $328.27
| Facility | | $129.47 | $257.86 | $328.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $137.35 / $177.81
| Professional | | $129.47 | $137.35 | $177.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.13 / $227.34 / $414.34
| Facility | | $141.13 | $227.34 | $414.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.15 / $122.15 / $183.23
| Facility | | $122.15 | $122.15 | $183.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.58 / $154.66 / $214.79
| Facility | | $129.58 | $154.66 | $214.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.11 / $142.43 / $212.35
| Professional | | $97.11 | $142.43 | $212.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |