- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.60 / $373.08 / $559.62
| Facility | | $199.60 | $373.08 | $559.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.10 / $151.10 / $181.32
| Professional | | $151.10 | $151.10 | $181.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.06 / $554.65 / $878.74
| Facility | | $146.06 | $554.65 | $878.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.60 / $149.22 / $988.85
| Professional | | $102.60 | $149.22 | $988.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.56 / $158.56 / $158.56
| Facility | | $158.56 | $158.56 | $158.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.56 / $158.56 / $158.56
| Professional | | $158.56 | $158.56 | $158.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.03 / $177.21 / $216.07
| Facility | | $58.03 | $177.21 | $216.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $155.44 / $155.44
| Professional | | $155.44 | $155.44 | $155.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $155.44 / $155.44
| Professional | | $155.44 | $155.44 | $155.44 |