- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.37 / $176.26 / $248.51
| Facility | | $171.37 | $176.26 | $248.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $176.26 / $197.48
| Professional | | $164.25 | $176.26 | $197.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.70 / $218.70 / $218.70
| Professional | | $218.70 | $218.70 | $218.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.35 / $96.78 / $153.44
| Facility | | $61.35 | $96.78 | $153.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.96 / $154.96 / $164.25
| Facility | | $154.96 | $154.96 | $164.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $164.25 / $164.25
| Professional | | $164.25 | $164.25 | $164.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.40 / $176.26 / $246.76
| Facility | | $113.40 | $176.26 | $246.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.36 / $163.21 / $205.32
| Professional | | $145.36 | $163.21 | $205.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.25 / $164.25 / $195.46
| Professional | | $164.25 | $164.25 | $195.46 |