- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.07 / $170.07 / $343.60
| Facility | | $170.07 | $170.07 | $343.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.53 / $171.09 / $184.55
| Professional | | $163.53 | $171.09 | $184.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.44 / $307.52 / $343.60
| Facility | | $271.44 | $307.52 | $343.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.16 / $183.63 / $687.20
| Professional | | $180.16 | $183.63 | $687.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.10 / $377.96 / $515.40
| Facility | | $259.10 | $377.96 | $515.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.06 / $377.96 / $463.86
| Professional | | $292.06 | $377.96 | $463.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.25 / $192.25 / $343.60
| Facility | | $192.25 | $192.25 | $343.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.34 / $192.25 / $352.47
| Professional | | $140.34 | $192.25 | $352.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $166.07 / $253.13
| Professional | | $102.33 | $166.07 | $253.13 |