- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.90 / $182.90 / $211.04
| Facility | | $182.90 | $182.90 | $211.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.90 / $188.81 / $214.24
| Professional | | $182.90 | $188.81 | $214.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.59 / $535.59 / $535.59
| Facility | | $535.59 | $535.59 | $535.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.22 / $235.22 / $535.59
| Professional | | $235.22 | $235.22 | $535.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.00 / $251.00 / $394.29
| Facility | | $251.00 | $251.00 | $394.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.23 / $251.00 / $353.98
| Professional | | $183.23 | $251.00 | $353.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.83 / $428.47 / $696.27
| Professional | | $297.83 | $428.47 | $696.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.78 / $345.78 / $345.78
| Facility | | $345.78 | $345.78 | $345.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.91 / $200.40 / $334.00
| Professional | | $156.91 | $200.40 | $334.00 |