- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.23 / $464.23 / $724.20
| Facility | | $464.23 | $464.23 | $724.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.25 / $464.23 / $464.23
| Professional | | $420.25 | $464.23 | $464.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.41 / $552.76 / $970.82
| Facility | | $396.41 | $552.76 | $970.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.18 / $366.50 / $392.16
| Professional | | $348.18 | $366.50 | $392.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.33 / $400.66 / $1,099.49
| Professional | | $248.33 | $400.66 | $1,099.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.02 / $464.23 / $853.02
| Facility | | $441.02 | $464.23 | $853.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.79 / $650.57 / $744.90
| Professional | | $439.79 | $650.57 | $744.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.61 / $445.07 / $546.22
| Professional | | $404.61 | $445.07 | $546.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.24 / $399.98 / $682.72
| Professional | | $205.24 | $399.98 | $682.72 |