- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.73 / $309.08 / $363.64
| Facility | | $272.73 | $309.08 | $363.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.73 / $353.33 / $428.66
| Professional | | $272.73 | $353.33 | $428.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.50 / $921.85 / $1,077.96
| Professional | | $773.50 | $921.85 | $1,077.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.25 / $470.79 / $582.66
| Professional | | $419.25 | $470.79 | $582.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.64 / $514.05 / $724.84
| Facility | | $363.64 | $514.05 | $724.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.47 / $680.12 / $2,551.41
| Professional | | $368.47 | $680.12 | $2,551.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.47 / $673.00 / $862.57
| Professional | | $368.47 | $673.00 | $862.57 |