- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.60 / $148.60 / $381.53
| Facility | | $148.60 | $148.60 | $381.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.60 / $206.12 / $381.53
| Professional | | $148.60 | $206.12 | $381.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.65 / $458.65 / $458.65
| Facility | | $458.65 | $458.65 | $458.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.58 / $218.58 / $485.23
| Professional | | $218.58 | $218.58 | $485.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.48 / $292.48 / $337.66
| Facility | | $292.48 | $292.48 | $337.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.51 / $292.48 / $303.14
| Professional | | $213.51 | $292.48 | $303.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.05 / $366.92 / $596.25
| Professional | | $255.05 | $366.92 | $596.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.16 / $181.55 / $302.58
| Professional | | $142.16 | $181.55 | $302.58 |