- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.07 / $240.11 / $372.17
| Facility | | $150.07 | $240.11 | $372.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.07 / $150.07 / $150.07
| Professional | | $150.07 | $150.07 | $150.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.56 / $146.54 / $8,639.91
| Facility | | $124.56 | $146.54 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.54 / $146.54 / $146.54
| Professional | | $146.54 | $146.54 | $146.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.07 / $231.11 / $372.17
| Facility | | $150.07 | $231.11 | $372.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.07 / $150.07 / $298.64
| Professional | | $150.07 | $150.07 | $298.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.80 / $136.80 / $193.21
| Professional | | $136.80 | $136.80 | $193.21 |