- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.83 / $188.83 / $226.60
| Facility | | $188.83 | $188.83 | $226.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.02 / $146.53 / $188.83
| Professional | | $138.02 | $146.53 | $188.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.36 / $335.36 / $397.54
| Facility | | $335.36 | $335.36 | $397.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.63 / $183.63 / $196.33
| Professional | | $183.63 | $183.63 | $196.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.25 / $192.25 / $192.25
| Facility | | $192.25 | $192.25 | $192.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.34 / $140.34 / $192.25
| Professional | | $140.34 | $140.34 | $192.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.52 / $271.52 / $838.05
| Professional | | $271.52 | $271.52 | $838.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.54 / $167.30 / $214.22
| Professional | | $111.54 | $167.30 | $214.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.10 / $241.01 / $306.74
| Professional | | $219.10 | $241.01 | $306.74 |