- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.41 / $148.41 / $371.03
| Facility | | $148.41 | $148.41 | $371.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.21 / $120.21 / $148.41
| Professional | | $120.21 | $120.21 | $148.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.62 / $198.13 / $1,550.59
| Facility | | $143.62 | $198.13 | $1,550.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.36 / $59.36 / $171.66
| Professional | | $59.36 | $59.36 | $171.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.21 / $201.42 / $316.57
| Facility | | $171.21 | $201.42 | $316.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.25 / $178.30 / $213.21
| Professional | | $150.25 | $178.30 | $213.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.41 / $148.41 / $179.72
| Professional | | $148.41 | $148.41 | $179.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.41 / $148.41 / $371.03
| Facility | | $148.41 | $148.41 | $371.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.21 / $120.21 / $148.41
| Professional | | $120.21 | $120.21 | $148.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.05 / $121.30 / $293.13
| Professional | | $89.05 | $121.30 | $293.13 |