- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.26 / $140.26 / $161.83
| Facility | | $140.26 | $140.26 | $161.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.26 / $161.19 / $164.28
| Professional | | $140.26 | $161.19 | $164.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.71 / $410.71 / $410.71
| Facility | | $410.71 | $410.71 | $410.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $525.14
| Professional | | $239.88 | $239.88 | $525.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.11 / $246.11 / $302.37
| Facility | | $246.11 | $246.11 | $302.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.66 / $246.10 / $313.30
| Professional | | $179.66 | $246.10 | $313.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.40 / $328.57 / $533.91
| Professional | | $228.40 | $328.57 | $533.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.85 / $196.49 / $327.48
| Professional | | $153.85 | $196.49 | $327.48 |