- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.61 / $304.81 / $731.54
| Facility | | $228.61 | $304.81 | $731.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.56 / $225.56 / $326.14
| Professional | | $225.56 | $225.56 | $326.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.73 / $525.79 / $761.61
| Facility | | $387.73 | $525.79 | $761.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.57 / $289.57 / $289.57
| Professional | | $289.57 | $289.57 | $289.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.13 / $198.13 / $814.31
| Facility | | $198.13 | $198.13 | $814.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.75 / $371.24 / $444.78
| Professional | | $135.75 | $371.24 | $444.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.56 / $304.81 / $512.08
| Facility | | $225.56 | $304.81 | $512.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $128.02 / $457.22
| Professional | | $128.02 | $128.02 | $457.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.02 / $128.02 / $195.08
| Professional | | $128.02 | $128.02 | $195.08 |