- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.94 / $238.20 / $272.91
| Facility | | $214.94 | $238.20 | $272.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.44 / $245.85 / $454.26
| Professional | | $186.44 | $245.85 | $454.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.09 / $389.09 / $389.09
| Professional | | $389.09 | $389.09 | $389.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.02 / $297.02 / $297.02
| Facility | | $297.02 | $297.02 | $297.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.82 / $216.82 / $308.77
| Professional | | $216.82 | $216.82 | $308.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.11 / $318.58 / $318.58
| Facility | | $194.11 | $318.58 | $318.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.30 / $346.63 / $518.78
| Professional | | $277.30 | $346.63 | $518.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.40 / $297.54 / $327.29
| Professional | | $193.40 | $297.54 | $327.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.65 / $253.42 / $326.02
| Professional | | $202.65 | $253.42 | $326.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.54 / $297.54 / $297.54
| Professional | | $297.54 | $297.54 | $297.54 |