- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.79 / $251.79 / $251.79
| Facility | | $251.79 | $251.79 | $251.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.11 / $288.19 / $557.46
| Facility | | $219.11 | $288.19 | $557.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.25 / $566.25 / $584.04
| Professional | | $514.25 | $566.25 | $584.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.36 / $646.91 / $808.66
| Professional | | $427.36 | $646.91 | $808.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.21 / $235.05 / $1,691.62
| Facility | | $128.21 | $235.05 | $1,691.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.68 / $213.68 / $1,029.22
| Professional | | $213.68 | $213.68 | $1,029.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.36 / $651.28 / $780.49
| Facility | | $427.36 | $651.28 | $780.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.36 / $700.83 / $911.69
| Professional | | $427.36 | $700.83 | $911.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.67 / $416.67 / $726.51
| Professional | | $416.67 | $416.67 | $726.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.99 / $213.68 / $231.48
| Professional | | $202.99 | $213.68 | $231.48 |