- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.72 / $128.72 / $321.83
| Facility | | $128.72 | $128.72 | $321.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.27 / $104.27 / $128.72
| Professional | | $104.27 | $104.27 | $128.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.57 / $189.23 / $445.02
| Facility | | $124.57 | $189.23 | $445.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.49 / $51.49 / $83.67
| Professional | | $51.49 | $51.49 | $83.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.56 / $274.56 / $274.56
| Facility | | $274.56 | $274.56 | $274.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.53 / $130.28 / $237.94
| Professional | | $90.53 | $130.28 | $237.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $128.72 / $130.02
| Professional | | $128.72 | $128.72 | $130.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.72 / $128.72 / $321.83
| Facility | | $128.72 | $128.72 | $321.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.27 / $128.72 / $128.72
| Professional | | $104.27 | $128.72 | $128.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.63 / $77.23 / $98.09
| Professional | | $33.63 | $77.23 | $98.09 |