- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.39 / $199.39 / $199.39
| Facility | | $199.39 | $199.39 | $199.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.39 / $230.99 / $1,951.56
| Professional | | $199.39 | $230.99 | $1,951.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.84 / $386.84 / $386.84
| Facility | | $386.84 | $386.84 | $386.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.39 / $386.83 / $398.45
| Professional | | $282.39 | $386.83 | $398.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.09 / $511.45 / $664.88
| Professional | | $317.09 | $511.45 | $664.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.46 / $684.17 / $684.17
| Facility | | $613.46 | $684.17 | $684.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.59 / $490.41 / $735.62
| Professional | | $389.59 | $490.41 | $735.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.29 / $308.85 / $362.74
| Professional | | $237.29 | $308.85 | $362.74 |