- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.66 / $108.55 / $108.55
| Facility | | $79.66 | $108.55 | $108.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.18 / $117.48 / $171.53
| Professional | | $89.18 | $117.48 | $171.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.81 / $255.16 / $341.83
| Professional | | $198.81 | $255.16 | $341.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.96 / $170.47 / $278.79
| Facility | | $106.96 | $170.47 | $278.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.65 / $299.27 / $873.44
| Professional | | $128.65 | $299.27 | $873.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.52 / $223.48 / $289.55
| Facility | | $162.52 | $223.48 | $289.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.39 / $223.48 / $283.74
| Professional | | $194.39 | $223.48 | $283.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.25 / $173.37 / $219.33
| Professional | | $117.25 | $173.37 | $219.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $821.00 / $821.00
| Facility | | $821.00 | $821.00 | $821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.65 / $201.01 / $312.68
| Professional | | $128.65 | $201.01 | $312.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.00 / $206.70 / $273.80
| Professional | | $169.00 | $206.70 | $273.80 |