- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.51 / $207.04 / $237.21
| Facility | | $192.51 | $207.04 | $237.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $237.21 / $335.60
| Professional | | $192.51 | $237.21 | $335.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.70 / $315.70 / $315.70
| Facility | | $315.70 | $315.70 | $315.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.47 / $230.47 / $315.70
| Professional | | $230.47 | $230.47 | $315.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.24 / $300.17 / $300.17
| Facility | | $156.24 | $300.17 | $300.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.92 / $300.17 / $450.90
| Professional | | $214.92 | $300.17 | $450.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.62 / $239.43 / $263.37
| Professional | | $155.62 | $239.43 | $263.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.64 / $224.95 / $331.27
| Professional | | $193.64 | $224.95 | $331.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.43 / $239.43 / $266.68
| Professional | | $239.43 | $239.43 | $266.68 |