- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.50 / $341.95 / $1,555.95
| Professional | | $229.50 | $341.95 | $1,555.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.55 / $480.88 / $891.40
| Facility | | $405.55 | $480.88 | $891.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.54 / $383.01 / $392.62
| Professional | | $363.54 | $383.01 | $392.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.44 / $299.44 / $498.14
| Facility | | $299.44 | $299.44 | $498.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.44 / $299.44 / $365.81
| Professional | | $299.44 | $299.44 | $365.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.48 / $333.48 / $333.48
| Professional | | $333.48 | $333.48 | $333.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.50 / $277.30 / $1,555.95
| Professional | | $209.50 | $277.30 | $1,555.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.85 / $333.48 / $876.09
| Professional | | $156.85 | $333.48 | $876.09 |