- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.28 / $134.28 / $235.93
| Facility | | $134.28 | $134.28 | $235.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.28 / $246.10 / $695.14
| Professional | | $134.28 | $246.10 | $695.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.16 / $214.16 / $291.73
| Facility | | $214.16 | $214.16 | $291.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.34 / $214.16 / $291.73
| Professional | | $156.34 | $214.16 | $291.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $245.74 / $319.46
| Professional | | $60.00 | $245.74 | $319.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.76 / $328.73 / $328.73
| Facility | | $294.76 | $328.73 | $328.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.19 / $235.63 / $353.45
| Professional | | $187.19 | $235.63 | $353.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.69 / $155.62 / $165.61
| Facility | | $129.69 | $155.62 | $165.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.85 / $155.62 / $187.16
| Professional | | $121.85 | $155.62 | $187.16 |