- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $257.45 / $643.63
| Facility | | $257.45 | $257.45 | $643.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.53 / $208.53 / $257.45
| Professional | | $208.53 | $208.53 | $257.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.13 / $378.45 / $890.00
| Facility | | $249.13 | $378.45 | $890.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.98 / $102.98 / $167.34
| Professional | | $102.98 | $102.98 | $167.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.13 / $549.13 / $549.13
| Facility | | $549.13 | $549.13 | $549.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.28 / $260.57 / $464.28
| Professional | | $181.28 | $260.57 | $464.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.45 / $257.45 / $260.02
| Professional | | $257.45 | $257.45 | $260.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $257.45 / $643.63
| Facility | | $257.45 | $257.45 | $643.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.53 / $257.45 / $257.45
| Professional | | $208.53 | $257.45 | $257.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.23 / $154.47 / $257.45
| Professional | | $67.23 | $154.47 | $257.45 |