- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.71 / $208.71 / $250.45
| Facility | | $208.71 | $208.71 | $250.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.94 / $165.53 / $222.40
| Professional | | $161.94 | $165.53 | $222.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.68 / $370.68 / $439.40
| Facility | | $370.68 | $370.68 | $439.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.02 / $224.02 / $236.54
| Professional | | $224.02 | $224.02 | $236.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.78 / $239.78 / $239.78
| Facility | | $239.78 | $239.78 | $239.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.04 / $175.04 / $246.97
| Professional | | $175.04 | $175.04 | $246.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.12 / $300.12 / $926.32
| Professional | | $300.12 | $300.12 | $926.32 |
- 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 / $265.30
| Professional | | $123.28 | $184.93 | $265.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.62 / $305.38 / $388.67
| Professional | | $277.62 | $305.38 | $388.67 |