- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.63 / $370.63 / $370.63
| Facility | | $370.63 | $370.63 | $370.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.44 / $258.02 / $412.85
| Professional | | $133.44 | $258.02 | $412.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.48 / $307.87 / $327.50
| Facility | | $292.48 | $307.87 | $327.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.42 / $329.42 / $329.42
| Professional | | $329.42 | $329.42 | $329.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.52 / $274.52 / $274.52
| Facility | | $274.52 | $274.52 | $274.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $274.52 / $615.00
| Professional | | $200.41 | $274.52 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.44 / $397.24 / $2,227.59
| Facility | | $133.44 | $397.24 | $2,227.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.80 / $276.83 / $629.71
| Professional | | $137.80 | $276.83 | $629.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.94 / $245.90 / $327.82
| Professional | | $163.94 | $245.90 | $327.82 |