- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.90 / $150.22 / $272.70
| Facility | | $88.90 | $150.22 | $272.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.30 / $272.70 / $292.93
| Professional | | $266.30 | $272.70 | $292.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.68 / $826.68 / $826.68
| Facility | | $826.68 | $826.68 | $826.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $272.70 / $272.70
| Professional | | $267.37 | $272.70 | $272.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.70 / $272.70 / $272.70
| Facility | | $272.70 | $272.70 | $272.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $272.70 / $272.70
| Professional | | $272.70 | $272.70 | $272.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $272.70 / $326.73
| Professional | | $272.70 | $272.70 | $326.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.65 / $206.62 / $363.26
| Facility | | $90.65 | $206.62 | $363.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.30 / $272.70 / $306.24
| Professional | | $266.30 | $272.70 | $306.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $267.37 / $401.06
| Professional | | $267.37 | $267.37 | $401.06 |