- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.65 / $364.65 / $364.65
| Facility | | $364.65 | $364.65 | $364.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.51 / $238.91 / $364.65
| Professional | | $130.51 | $238.91 | $364.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.06 / $365.57 / $387.75
| Facility | | $335.06 | $365.57 | $387.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.86 / $362.86 / $362.86
| Professional | | $362.86 | $362.86 | $362.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.20 / $253.20 / $253.20
| Facility | | $253.20 | $253.20 | $253.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.84 / $253.20 / $651.55
| Professional | | $184.84 | $253.20 | $651.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.51 / $354.89 / $2,141.94
| Facility | | $130.51 | $354.89 | $2,141.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.77 / $219.69 / $562.58
| Professional | | $134.77 | $219.69 | $562.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.90 / $209.89 / $294.23
| Professional | | $136.90 | $209.89 | $294.23 |