- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $812.83
| Professional | | $281.84 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $489.78 / $501.19
| Professional | | $446.68 | $489.78 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $489.78
| Professional | | $223.87 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $575.44
| Facility | | $446.68 | $501.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $575.44
| Professional | | $446.68 | $501.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $371.54 / $588.84
| Facility | | $281.84 | $371.54 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $426.58 / $645.65
| Professional | | $79.43 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $549.54
| Professional | | $331.13 | $446.68 | $549.54 |