- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.33 / $320.33 / $384.40
| Facility | | $320.33 | $320.33 | $384.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.13 / $248.57 / $320.33
| Professional | | $234.13 | $248.57 | $320.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.90 / $568.90 / $674.37
| Facility | | $568.90 | $568.90 | $674.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.64 / $316.64 / $332.28
| Professional | | $316.64 | $316.64 | $332.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.37 / $325.37 / $325.37
| Facility | | $325.37 | $325.37 | $325.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.52 / $325.37 / $465.03
| Professional | | $237.52 | $325.37 | $465.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.61 / $460.61 / $1,421.67
| Professional | | $460.61 | $460.61 | $1,421.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.46 / $283.82 / $460.61
| Professional | | $195.46 | $283.82 | $460.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.69 / $408.86 / $520.37
| Professional | | $371.69 | $408.86 | $520.37 |