- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.41 / $176.41 / $370.68
| Facility | | $176.41 | $176.41 | $370.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.41 / $181.00 / $206.12
| Professional | | $176.41 | $181.00 | $206.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.83 / $331.76 / $370.68
| Facility | | $292.83 | $331.76 | $370.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.71 / $224.02 / $307.70
| Professional | | $185.71 | $224.02 | $307.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.44 / $407.75 / $556.02
| Facility | | $309.44 | $407.75 | $556.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.08 / $407.75 / $500.42
| Professional | | $315.08 | $407.75 | $500.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.78 / $239.78 / $370.68
| Facility | | $239.78 | $239.78 | $370.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.04 / $239.78 / $380.24
| Professional | | $175.04 | $239.78 | $380.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.02 / $247.02 / $247.02
| Facility | | $247.02 | $247.02 | $247.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.28 / $184.93 / $278.63
| Professional | | $123.28 | $184.93 | $278.63 |