- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $457.09 / $912.01
| Facility | | $239.88 | $457.09 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $245.47
| Professional | | $173.78 | $213.80 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $251.19
| Professional | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $407.38 / $562.34
| Facility | | $173.78 | $407.38 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $288.40 / $363.08
| Professional | | $281.84 | $288.40 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $426.58
| Facility | | $162.18 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $245.47
| Professional | | $104.71 | $147.91 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $245.47 / $295.12
| Facility | | $104.71 | $245.47 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $245.47
| Professional | | $104.71 | $147.91 | $245.47 |