- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.50 / $345.50 / $1,397.10
| Facility | | $345.50 | $345.50 | $1,397.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.77 / $345.50 / $345.50
| Professional | | $310.77 | $345.50 | $345.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.74 / $384.14 / $604.82
| Facility | | $254.74 | $384.14 | $604.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $381.58 / $449.98
| Professional | | $329.05 | $381.58 | $449.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.43 / $329.05 / $329.05
| Facility | | $310.43 | $329.05 | $329.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $329.05
| Professional | | $329.05 | $329.05 | $329.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.50 / $381.58 / $807.42
| Facility | | $345.50 | $381.58 | $807.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.97 / $528.97 / $528.97
| Professional | | $528.97 | $528.97 | $528.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $329.05
| Professional | | $329.05 | $329.05 | $329.05 |