- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.02 / $285.02 / $712.58
| Facility | | $285.02 | $285.02 | $712.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.87 / $230.87 / $285.02
| Professional | | $230.87 | $230.87 | $285.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.82 / $380.52 / $1,101.36
| Facility | | $275.82 | $380.52 | $1,101.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.01 / $114.01 / $185.26
| Professional | | $114.01 | $114.01 | $185.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.34 / $138.47 / $231.45
| Facility | | $123.34 | $138.47 | $231.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.32 / $137.68 / $409.39
| Professional | | $121.32 | $137.68 | $409.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.02 / $285.02 / $345.17
| Professional | | $285.02 | $285.02 | $345.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.02 / $285.02 / $712.58
| Facility | | $285.02 | $285.02 | $712.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.87 / $230.87 / $285.02
| Professional | | $230.87 | $230.87 | $285.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.69 / $171.02 / $285.02
| Professional | | $82.69 | $171.02 | $285.02 |