- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.62 / $226.84 / $279.89
| Facility | | $129.62 | $226.84 | $279.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.62 / $129.62 / $1,260.80
| Professional | | $129.62 | $129.62 | $1,260.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.45 / $500.30 / $975.56
| Facility | | $383.45 | $500.30 | $975.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.39 / $20.42 / $20.42
| Professional | | $19.39 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.88 / $32.34 / $56.88
| Professional | | $25.88 | $32.34 | $56.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.88 / $137.72 / $246.28
| Facility | | $42.88 | $137.72 | $246.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.91 / $153.91 / $230.88
| Professional | | $153.91 | $153.91 | $230.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.57 / $33.00 / $56.88
| Facility | | $27.57 | $33.00 | $56.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.31 / $38.68 / $56.88
| Professional | | $28.31 | $38.68 | $56.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.22 / $153.91 / $162.02
| Professional | | $146.22 | $153.91 | $162.02 |