- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.52 / $152.35 / $216.38
| Facility | | $143.52 | $152.35 | $216.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.32 / $152.35 / $220.80
| Professional | | $120.32 | $152.35 | $220.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.13 / $394.86 / $555.02
| Facility | | $231.13 | $394.86 | $555.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.62 / $188.53 / $188.53
| Professional | | $157.62 | $188.53 | $188.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.47 / $166.47 / $166.47
| Facility | | $166.47 | $166.47 | $166.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.52 / $166.47 / $166.47
| Professional | | $121.52 | $166.47 | $166.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.31 / $132.47 / $167.27
| Professional | | $70.31 | $132.47 | $167.27 |