- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $478.63
| Facility | | $162.18 | $234.42 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $354.81
| Professional | | $162.18 | $234.42 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $870.96
| Facility | | $177.83 | $245.47 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $245.47 / $501.19
| Professional | | $229.09 | $245.47 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $1,862.09
| Facility | | $245.47 | $245.47 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $724.44
| Professional | | $177.83 | $177.83 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $537.03
| Facility | | $147.91 | $234.42 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $199.53 / $331.13
| Professional | | $154.88 | $199.53 | $331.13 |