- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.86 / $281.98 / $422.97
| Facility | | $150.86 | $281.98 | $422.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.47 / $155.09 / $185.36
| Professional | | $154.47 | $155.09 | $185.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.34 / $356.52 / $702.84
| Facility | | $112.34 | $356.52 | $702.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.46 / $135.94 / $896.88
| Professional | | $93.46 | $135.94 | $896.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.11 / $140.99 / $140.99
| Facility | | $134.11 | $140.99 | $140.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.21 / $178.59 / $220.89
| Facility | | $139.21 | $178.59 | $220.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.43 / $140.43 / $154.91
| Professional | | $140.43 | $140.43 | $154.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |