- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.45 / $474.26 / $1,025.42
| Facility | | $320.45 | $474.26 | $1,025.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.17 / $316.17 / $320.45
| Professional | | $316.17 | $316.17 | $320.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.72 / $277.72 / $1,141.43
| Facility | | $277.72 | $277.72 | $1,141.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.52 / $520.52 / $623.64
| Professional | | $520.52 | $520.52 | $623.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.17 / $427.26 / $717.80
| Facility | | $316.17 | $427.26 | $717.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.45 / $179.45 / $640.89
| Professional | | $179.45 | $179.45 | $640.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.71 / $512.71 / $512.71
| Facility | | $512.71 | $512.71 | $512.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.45 / $179.45 / $427.26
| Professional | | $179.45 | $179.45 | $427.26 |