- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.06 / $347.28 / $362.91
| Facility | | $184.06 | $347.28 | $362.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.10 / $238.46 / $262.30
| Professional | | $210.10 | $238.46 | $262.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.31 / $418.69 / $763.07
| Facility | | $262.31 | $418.69 | $763.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $238.46
| Professional | | $238.46 | $238.46 | $238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.96 / $224.96 / $633.88
| Facility | | $224.96 | $224.96 | $633.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $238.46
| Professional | | $238.46 | $238.46 | $238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.64 / $252.76 / $600.62
| Facility | | $173.64 | $252.76 | $600.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.92 / $262.30 / $357.69
| Professional | | $259.92 | $262.30 | $357.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $257.54
| Professional | | $238.46 | $238.46 | $257.54 |