- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.45 / $645.45 / $929.84
| Facility | | $645.45 | $645.45 | $929.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $336.17 / $336.17
| Professional | | $4.78 | $336.17 | $336.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.69 / $378.91 / $1,394.76
| Facility | | $348.69 | $378.91 | $1,394.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.62 / $410.94 / $513.66
| Professional | | $339.62 | $410.94 | $513.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.17 / $697.38 / $739.22
| Facility | | $336.17 | $697.38 | $739.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.63 / $357.63 / $429.16
| Professional | | $357.63 | $357.63 | $429.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.45 / $715.26 / $1,287.47
| Facility | | $536.45 | $715.26 | $1,287.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.99 / $534.32 / $552.19
| Professional | | $303.99 | $534.32 | $552.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.19 / $150.19 / $429.16
| Professional | | $150.19 | $150.19 | $429.16 |