- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.38 / $203.22 / $209.73
| Facility | | $137.38 | $203.22 | $209.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.38 / $172.68 / $286.23
| Professional | | $137.38 | $172.68 | $286.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.72 / $315.76 / $1,388.12
| Facility | | $300.72 | $315.76 | $1,388.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.24 / $183.72 / $243.40
| Professional | | $167.24 | $183.72 | $243.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.68 / $225.68 / $225.68
| Facility | | $225.68 | $225.68 | $225.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.75 / $164.75 / $240.59
| Professional | | $164.75 | $164.75 | $240.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.38 / $242.35 / $1,614.69
| Facility | | $137.38 | $242.35 | $1,614.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.02 / $166.61 / $308.20
| Professional | | $125.02 | $166.61 | $308.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.02 / $162.53 / $231.18
| Professional | | $125.02 | $162.53 | $231.18 |