- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.58 / $247.58 / $247.58
| Facility | | $247.58 | $247.58 | $247.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.62 / $228.53 / $267.39
| Professional | | $161.62 | $228.53 | $267.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.14 / $340.14 / $453.52
| Professional | | $340.14 | $340.14 | $453.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.33 / $328.92 / $367.51
| Facility | | $290.33 | $328.92 | $367.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.08 / $374.60 / $485.44
| Professional | | $295.08 | $374.60 | $485.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.75 / $303.20 / $559.72
| Facility | | $36.75 | $303.20 | $559.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.07 / $289.42 / $515.16
| Professional | | $33.07 | $289.42 | $515.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.78 / $243.78 / $326.36
| Facility | | $243.78 | $243.78 | $326.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.21 / $243.78 / $494.47
| Professional | | $207.21 | $243.78 | $494.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.77 / $198.22 / $362.42
| Professional | | $124.77 | $198.22 | $362.42 |