- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.52 / $206.52 / $297.52
| Facility | | $206.52 | $206.52 | $297.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.09 / $223.14 / $223.14
| Professional | | $80.09 | $223.14 | $223.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.57 / $121.24 / $446.28
| Facility | | $111.57 | $121.24 | $446.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.67 / $131.75 / $164.68
| Professional | | $108.67 | $131.75 | $164.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.56 / $223.14 / $236.53
| Facility | | $107.56 | $223.14 | $236.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $137.32
| Professional | | $114.43 | $114.43 | $137.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $114.43
| Professional | | $114.43 | $114.43 | $114.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.65 / $228.86 / $411.95
| Facility | | $171.65 | $228.86 | $411.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.27 / $171.14 / $176.91
| Professional | | $97.27 | $171.14 | $176.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.06 / $48.06 / $137.32
| Professional | | $48.06 | $48.06 | $137.32 |