- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $424.73 / $458.70
| Facility | | $175.40 | $424.73 | $458.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.07 / $142.07 / $175.40
| Professional | | $142.07 | $142.07 | $175.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.73 / $257.83 / $606.36
| Facility | | $169.73 | $257.83 | $606.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.16 / $70.16 / $169.86
| Professional | | $70.16 | $70.16 | $169.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.12 / $374.12 / $374.12
| Facility | | $374.12 | $374.12 | $374.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.10 / $177.42 / $185.42
| Professional | | $111.10 | $177.42 | $185.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.40 / $175.40 / $177.15
| Professional | | $175.40 | $175.40 | $177.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $175.40 / $784.04
| Facility | | $175.40 | $175.40 | $784.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.07 / $175.40 / $175.40
| Professional | | $142.07 | $175.40 | $175.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.24 / $107.39 / $268.47
| Professional | | $105.24 | $107.39 | $268.47 |