- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $207.13
| Facility | | $207.13 | $207.13 | $207.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $207.13 / $227.84
| Professional | | $207.13 | $207.13 | $227.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.98 / $203.60 / $440.51
| Facility | | $185.98 | $203.60 | $440.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.14 / $210.01 / $216.43
| Professional | | $173.14 | $210.01 | $216.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.97 / $660.76 / $804.43
| Facility | | $383.97 | $660.76 | $804.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.91 / $229.80 / $265.32
| Professional | | $208.91 | $229.80 | $265.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.20 / $584.17 / $724.91
| Facility | | $331.20 | $584.17 | $724.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.91 / $208.91 / $221.28
| Professional | | $208.91 | $208.91 | $221.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.13 / $206.13 / $454.08
| Facility | | $206.13 | $206.13 | $454.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.13 / $229.47 / $530.10
| Professional | | $206.13 | $229.47 | $530.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.13 / $224.41 / $396.26
| Professional | | $207.13 | $224.41 | $396.26 |