- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.32 / $209.32 / $523.29
| Facility | | $209.32 | $209.32 | $523.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.55 / $169.55 / $209.32
| Professional | | $169.55 | $169.55 | $209.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.56 / $279.44 / $1,378.87
| Facility | | $202.56 | $279.44 | $1,378.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.73 / $83.73 / $152.63
| Professional | | $83.73 | $83.73 | $152.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.44 / $180.53 / $302.04
| Facility | | $153.44 | $180.53 | $302.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.91 / $179.58 / $300.45
| Professional | | $169.91 | $179.58 | $300.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.32 / $209.32 / $253.49
| Professional | | $209.32 | $209.32 | $253.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.32 / $209.32 / $523.29
| Facility | | $209.32 | $209.32 | $523.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.55 / $169.55 / $209.32
| Professional | | $169.55 | $169.55 | $209.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.86 / $125.59 / $260.64
| Professional | | $107.86 | $125.59 | $260.64 |