- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.77 / $429.77 / $429.77
| Facility | | $429.77 | $429.77 | $429.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.15 / $281.57 / $429.77
| Professional | | $167.15 | $281.57 | $429.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.84 / $427.51 / $453.45
| Facility | | $391.84 | $427.51 | $453.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.34 / $424.34 / $424.34
| Professional | | $424.34 | $424.34 | $424.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.30 / $324.30 / $324.30
| Facility | | $324.30 | $324.30 | $324.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.74 / $236.74 / $938.44
| Professional | | $236.74 | $236.74 | $938.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.15 / $418.27 / $2,792.04
| Facility | | $167.15 | $418.27 | $2,792.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.62 / $258.92 / $663.05
| Professional | | $172.62 | $258.92 | $663.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.62 / $258.92 / $346.78
| Professional | | $172.62 | $258.92 | $346.78 |