- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.28 / $324.16 / $324.16
| Facility | | $131.28 | $324.16 | $324.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.66 / $131.28 / $137.77
| Professional | | $129.66 | $131.28 | $137.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.47 / $327.16 / $809.07
| Facility | | $138.47 | $327.16 | $809.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.63 / $173.10 / $408.94
| Professional | | $140.63 | $173.10 | $408.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.08 / $162.08 / $162.08
| Facility | | $162.08 | $162.08 | $162.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.08 / $162.08 / $162.08
| Professional | | $162.08 | $162.08 | $162.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.28 / $144.41 / $266.50
| Facility | | $131.28 | $144.41 | $266.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.08 / $162.08 / $162.08
| Professional | | $162.08 | $162.08 | $162.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.08 / $162.08 / $162.08
| Professional | | $162.08 | $162.08 | $162.08 |