- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.47 / $147.47 / $147.47
| Facility | | $147.47 | $147.47 | $147.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.04 / $147.47 / $158.97
| Professional | | $107.04 | $147.47 | $158.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.06 / $176.06 / $176.06
| Facility | | $176.06 | $176.06 | $176.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.16 / $176.06 / $176.06
| Professional | | $145.16 | $176.06 | $176.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.78 / $502.73 / $632.15
| Facility | | $401.78 | $502.73 | $632.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.04 / $224.40 / $259.08
| Professional | | $206.04 | $224.40 | $259.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.78 / $497.75 / $1,044.28
| Facility | | $401.78 | $497.75 | $1,044.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $204.00 / $204.00
| Professional | | $85.00 | $204.00 | $204.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.66 / $156.94 / $184.86
| Facility | | $130.66 | $156.94 | $184.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.56 / $73.20 / $164.09
| Professional | | $58.56 | $73.20 | $164.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.56 / $73.20 / $176.06
| Professional | | $58.56 | $73.20 | $176.06 |