- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.44 / $395.82 / $840.74
| Facility | | $294.44 | $395.82 | $840.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.20 / $294.44 / $294.44
| Professional | | $283.20 | $294.44 | $294.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.17 / $458.57 / $893.59
| Facility | | $289.17 | $458.57 | $893.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.72 / $283.72 / $283.72
| Professional | | $283.72 | $283.72 | $283.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Facility | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.87 / $323.87 / $323.87
| Professional | | $323.87 | $323.87 | $323.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.76 / $311.76 / $311.76
| Facility | | $311.76 | $311.76 | $311.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.76 / $346.40 / $346.40
| Professional | | $311.76 | $346.40 | $346.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.17 / $289.17 / $318.69
| Professional | | $289.17 | $289.17 | $318.69 |