- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.12 / $226.12 / $226.12
| Facility | | $226.12 | $226.12 | $226.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.85 / $157.43 / $251.88
| Professional | | $96.85 | $157.43 | $251.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.63 / $322.54 / $342.12
| Facility | | $295.63 | $322.54 | $342.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.14 / $320.14 / $320.14
| Professional | | $320.14 | $320.14 | $320.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.68 / $225.68 / $225.68
| Facility | | $225.68 | $225.68 | $225.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.75 / $225.68 / $505.78
| Professional | | $164.75 | $225.68 | $505.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.85 / $242.35 / $1,614.69
| Facility | | $96.85 | $242.35 | $1,614.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.02 / $172.18 / $384.17
| Professional | | $100.02 | $172.18 | $384.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.02 / $150.02 / $231.18
| Professional | | $100.02 | $150.02 | $231.18 |