- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.38 / $256.38 / $256.38
| Facility | | $256.38 | $256.38 | $256.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.38 / $393.73 / $2,011.42
| Professional | | $256.38 | $393.73 | $2,011.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.26 / $417.68 / $497.67
| Professional | | $313.26 | $417.68 | $497.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.35 / $373.35 / $373.35
| Facility | | $373.35 | $373.35 | $373.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.55 / $373.35 / $373.35
| Professional | | $272.55 | $373.35 | $373.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.28 / $522.86 / $784.29
| Professional | | $418.28 | $522.86 | $784.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.40 / $168.40 / $392.93
| Facility | | $168.40 | $168.40 | $392.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.55 / $373.35 / $646.98
| Professional | | $272.55 | $373.35 | $646.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.85 / $260.85 / $392.93
| Professional | | $236.85 | $260.85 | $392.93 |