- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $263.03 / $263.03
| Facility | | $239.88 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $407.38
| Professional | | $104.71 | $104.71 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $120.23 / $331.13
| Facility | | $102.33 | $120.23 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $562.34
| Facility | | $104.71 | $104.71 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $158.49 / $194.98
| Professional | | $151.36 | $158.49 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $263.03
| Facility | | $239.88 | $239.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $125.89 / $407.38
| Professional | | $104.71 | $125.89 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $380.19
| Professional | | $104.71 | $104.71 | $380.19 |