- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.62 / $214.62 / $536.54
| Facility | | $214.62 | $214.62 | $536.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.84 / $173.84 / $214.62
| Professional | | $173.84 | $173.84 | $214.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.69 / $315.49 / $1,011.70
| Facility | | $207.69 | $315.49 | $1,011.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.85 / $85.85 / $207.93
| Professional | | $85.85 | $85.85 | $207.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.77 / $457.77 / $457.77
| Facility | | $457.77 | $457.77 | $457.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.02 / $217.36 / $226.75
| Professional | | $136.02 | $217.36 | $226.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.62 / $214.62 / $216.77
| Professional | | $214.62 | $214.62 | $216.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.62 / $214.62 / $536.54
| Facility | | $214.62 | $214.62 | $536.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.84 / $214.62 / $214.62
| Professional | | $173.84 | $214.62 | $214.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.77 / $131.46 / $328.65
| Professional | | $128.77 | $131.46 | $328.65 |