- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.46 / $207.46 / $518.65
| Facility | | $207.46 | $207.46 | $518.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.04 / $168.04 / $207.46
| Professional | | $168.04 | $168.04 | $207.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.76 / $304.97 / $5,068.53
| Facility | | $200.76 | $304.97 | $5,068.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.98 / $82.98 / $268.20
| Professional | | $82.98 | $82.98 | $268.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.51 / $442.51 / $442.51
| Facility | | $442.51 | $442.51 | $442.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.08 / $209.83 / $219.07
| Professional | | $146.08 | $209.83 | $219.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.46 / $207.46 / $209.53
| Professional | | $207.46 | $207.46 | $209.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.46 / $207.46 / $518.65
| Facility | | $207.46 | $207.46 | $518.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.04 / $207.46 / $207.46
| Professional | | $168.04 | $207.46 | $207.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.48 / $169.56 / $423.90
| Professional | | $124.48 | $169.56 | $423.90 |