- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $363.08 / $602.56
| Facility | | $223.87 | $363.08 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $48.98 / $169.82
| Professional | | $40.74 | $48.98 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $245.47
| Facility | | $51.29 | $51.29 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $165.96
| Professional | | $51.29 | $51.29 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $190.55 / $204.17
| Facility | | $177.83 | $190.55 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $141.25 / $245.47
| Facility | | $40.74 | $141.25 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $51.29 / $51.29
| Professional | | $31.62 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $102.33 / $154.88
| Professional | | $30.90 | $102.33 | $154.88 |