- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.56 / $177.56 / $443.90
| Facility | | $177.56 | $177.56 | $443.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.82 / $143.82 / $177.56
| Professional | | $143.82 | $143.82 | $177.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.82 / $237.04 / $1,270.41
| Facility | | $171.82 | $237.04 | $1,270.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.02 / $71.02 / $150.91
| Professional | | $71.02 | $71.02 | $150.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.01 / $190.60 / $378.72
| Facility | | $185.01 | $190.60 | $378.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.28 / $187.62 / $255.03
| Professional | | $76.28 | $187.62 | $255.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.56 / $177.56 / $215.03
| Professional | | $177.56 | $177.56 | $215.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.56 / $177.56 / $443.90
| Facility | | $177.56 | $177.56 | $443.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.82 / $143.82 / $177.56
| Professional | | $143.82 | $143.82 | $177.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.56 / $106.54 / $257.45
| Professional | | $90.56 | $106.54 | $257.45 |