- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.32 / $303.94 / $409.44
| Facility | | $286.32 | $303.94 | $409.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.54 / $303.94 / $338.63
| Professional | | $282.54 | $303.94 | $338.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.10 / $787.73 / $1,107.26
| Facility | | $461.10 | $787.73 | $1,107.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.45 / $376.13 / $376.13
| Professional | | $314.45 | $376.13 | $376.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.03 / $331.03 / $331.03
| Facility | | $331.03 | $331.03 | $331.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.65 / $331.03 / $331.03
| Professional | | $241.65 | $331.03 | $331.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.20 / $251.50 / $404.45
| Professional | | $176.20 | $251.50 | $404.45 |