- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $691.83
| Facility | | $275.42 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $602.56
| Professional | | $281.84 | $354.81 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $1,348.96
| Facility | | $275.42 | $380.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $363.08 / $812.83
| Professional | | $331.13 | $363.08 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $2,818.38
| Facility | | $380.19 | $380.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $977.24
| Professional | | $275.42 | $275.42 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $363.08 / $831.76
| Facility | | $229.09 | $363.08 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $524.81
| Professional | | $234.42 | $331.13 | $524.81 |