- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.74 / $568.54 / $720.41
| Facility | | $260.74 | $568.54 | $720.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.74 / $260.74 / $437.57
| Professional | | $260.74 | $260.74 | $437.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.45 / $224.52 / $226.79
| Facility | | $215.45 | $224.52 | $226.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.70 / $277.02 / $329.63
| Professional | | $263.70 | $277.02 | $329.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.20 / $495.41 / $1,186.65
| Facility | | $307.20 | $495.41 | $1,186.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.60 / $271.60 / $325.92
| Professional | | $271.60 | $271.60 | $325.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.45 / $307.45 / $307.45
| Facility | | $307.45 | $307.45 | $307.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.45 / $307.45 / $307.45
| Professional | | $307.45 | $307.45 | $307.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.02 / $271.60 / $325.92
| Professional | | $258.02 | $271.60 | $325.92 |