- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.76 / $303.99 / $908.65
| Facility | | $216.76 | $303.99 | $908.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.61 / $216.76 / $237.91
| Professional | | $195.61 | $216.76 | $237.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.83 / $237.91 / $793.02
| Facility | | $208.83 | $237.91 | $793.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.74 / $105.74 / $150.15
| Professional | | $105.74 | $105.74 | $150.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.33 / $343.64 / $370.08
| Facility | | $264.33 | $343.64 | $370.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.33 / $317.20 / $396.51
| Professional | | $264.33 | $317.20 | $396.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.82 / $264.33 / $614.59
| Facility | | $171.82 | $264.33 | $614.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.11 / $260.06 / $426.00
| Professional | | $112.11 | $260.06 | $426.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.33 / $264.33 / $264.33
| Facility | | $264.33 | $264.33 | $264.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.60 / $258.05 / $444.47
| Professional | | $158.60 | $258.05 | $444.47 |