- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.26 / $209.26 / $219.12
| Facility | | $209.26 | $209.26 | $219.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.95 / $180.89 / $268.99
| Professional | | $123.95 | $180.89 | $268.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.19 / $188.19 / $354.22
| Facility | | $188.19 | $188.19 | $354.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.19 / $349.13 / $436.41
| Professional | | $188.19 | $349.13 | $436.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.11 / $376.53 / $545.40
| Professional | | $286.11 | $376.53 | $545.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.29 / $399.45 / $1,580.76
| Facility | | $202.29 | $399.45 | $1,580.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.91 / $170.88 / $438.24
| Professional | | $148.91 | $170.88 | $438.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.18 / $354.22 / $457.52
| Facility | | $353.18 | $354.22 | $457.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.10 / $413.78 / $676.90
| Professional | | $290.10 | $413.78 | $676.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.91 / $160.65 / $378.84
| Professional | | $148.91 | $160.65 | $378.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.92 / $305.92 / $305.92
| Facility | | $305.92 | $305.92 | $305.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.68 / $305.92 / $305.92
| Professional | | $241.68 | $305.92 | $305.92 |