- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $524.81 / $758.58
| Facility | | $208.93 | $524.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $218.78 / $275.42
| Professional | | $190.55 | $218.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $660.69
| Professional | | $354.81 | $524.81 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $354.81 / $501.19
| Professional | | $151.36 | $354.81 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $331.13 / $630.96
| Facility | | $275.42 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $1,096.48
| Professional | | $165.96 | $275.42 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $354.81
| Professional | | $331.13 | $331.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $295.12 / $588.84
| Professional | | $275.42 | $295.12 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $630.96
| Facility | | $275.42 | $275.42 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $691.83
| Professional | | $165.96 | $165.96 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |