- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $251.19 / $346.74
| Professional | | $181.97 | $251.19 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $416.87 / $489.78
| Professional | | $245.47 | $416.87 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $363.08 / $776.25
| Facility | | $89.13 | $363.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $575.44
| Professional | | $263.03 | $263.03 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $251.19 / $281.84
| Professional | | $208.93 | $251.19 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $676.08
| Facility | | $186.21 | $316.23 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Professional | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $316.23 / $575.44
| Facility | | $275.42 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $316.23
| Professional | | $162.18 | $208.93 | $316.23 |