- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.72 / $184.72 / $246.11
| Facility | | $184.72 | $184.72 | $246.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.26 / $191.44 / $292.20
| Professional | | $182.26 | $191.44 | $292.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.86 / $370.50 / $1,628.80
| Facility | | $352.86 | $370.50 | $1,628.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.40 / $198.35 / $285.61
| Professional | | $175.40 | $198.35 | $285.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.94 / $197.94 / $197.94
| Facility | | $197.94 | $197.94 | $197.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.50 / $144.50 / $211.02
| Professional | | $144.50 | $144.50 | $211.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.62 / $285.61 / $1,651.29
| Facility | | $176.62 | $285.61 | $1,651.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.94 / $176.04 / $428.90
| Professional | | $130.94 | $176.04 | $428.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.94 / $176.04 / $305.42
| Professional | | $130.94 | $176.04 | $305.42 |