- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $575.44 / $1,047.13
| Facility | | $269.15 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $457.09
| Professional | | $346.74 | $346.74 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $954.99
| Facility | | $346.74 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $346.74 / $446.68
| Professional | | $295.12 | $346.74 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $346.74 / $512.86
| Facility | | $323.59 | $346.74 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $354.81 / $446.68
| Professional | | $346.74 | $354.81 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $346.74 / $467.74
| Facility | | $281.84 | $346.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $346.74 / $416.87
| Professional | | $316.23 | $346.74 | $416.87 |