- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.93 / $300.25 / $343.99
| Facility | | $270.93 | $300.25 | $343.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.18 / $343.99 / $572.59
| Professional | | $279.18 | $343.99 | $572.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.60 / $408.60 / $408.60
| Facility | | $408.60 | $408.60 | $408.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.27 / $298.27 / $435.59
| Professional | | $298.27 | $298.27 | $435.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.56 / $305.85 / $383.40
| Facility | | $226.56 | $305.85 | $383.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.66 / $404.50 / $653.91
| Professional | | $311.66 | $404.50 | $653.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.73 / $499.59 / $549.54
| Professional | | $324.73 | $499.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.49 / $326.23 / $468.02
| Professional | | $276.49 | $326.23 | $468.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.59 / $499.59 / $499.59
| Professional | | $499.59 | $499.59 | $499.59 |