- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $756.55
| Facility | | $302.62 | $302.62 | $756.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.12 / $245.12 / $302.62
| Professional | | $245.12 | $245.12 | $302.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.85 / $375.46 / $1,046.16
| Facility | | $292.85 | $375.46 | $1,046.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.82 / $121.05 / $196.70
| Professional | | $56.82 | $121.05 | $196.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.52 / $95.52 / $645.47
| Facility | | $95.52 | $95.52 | $645.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.63 / $271.67 / $319.64
| Professional | | $56.63 | $271.67 | $319.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $305.64
| Professional | | $302.62 | $302.62 | $305.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $756.55
| Facility | | $302.62 | $302.62 | $756.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.12 / $302.62 / $302.62
| Professional | | $245.12 | $302.62 | $302.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.13 / $85.32 / $181.57
| Professional | | $34.13 | $85.32 | $181.57 |