- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.52 / $204.52 / $204.52
| Facility | | $204.52 | $204.52 | $204.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.75 / $170.25 / $204.52
| Professional | | $155.75 | $170.25 | $204.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.12 / $420.80 / $481.44
| Facility | | $326.12 | $420.80 | $481.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.64 / $217.64 / $228.39
| Professional | | $217.64 | $217.64 | $228.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.81 / $297.81 / $297.81
| Facility | | $297.81 | $297.81 | $297.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.40 / $217.40 / $297.81
| Professional | | $217.40 | $217.40 | $297.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.52 / $273.52 / $273.52
| Facility | | $273.52 | $273.52 | $273.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.64 / $273.52 / $357.68
| Professional | | $232.64 | $273.52 | $357.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.38 / $227.38 / $227.38
| Professional | | $227.38 | $227.38 | $227.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.21 / $209.93 / $275.14
| Professional | | $160.21 | $209.93 | $275.14 |