- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.33 / $206.33 / $206.33
| Facility | | $206.33 | $206.33 | $206.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.34 / $185.65 / $206.33
| Professional | | $159.34 | $185.65 | $206.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.58 / $176.58 / $325.08
| Facility | | $176.58 | $176.58 | $325.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.25 / $344.25 / $430.31
| Professional | | $344.25 | $344.25 | $430.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.24 / $346.86 / $1,382.94
| Facility | | $205.24 | $346.86 | $1,382.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.61 / $191.38 / $324.14
| Professional | | $119.61 | $191.38 | $324.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.30 / $325.08 / $509.14
| Facility | | $270.30 | $325.08 | $509.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.24 / $329.66 / $621.24
| Professional | | $266.24 | $329.66 | $621.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.44 / $293.20 / $348.52
| Professional | | $250.44 | $293.20 | $348.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.64 / $154.41 / $249.64
| Professional | | $103.64 | $154.41 | $249.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.75 / $280.75 / $280.75
| Professional | | $280.75 | $280.75 | $280.75 |