- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $346.74 / $707.95
| Facility | | $245.47 | $346.74 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $512.86
| Professional | | $245.47 | $338.84 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $354.81 / $1,412.54
| Facility | | $257.04 | $354.81 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $363.08 / $794.33
| Professional | | $331.13 | $363.08 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $2,754.23
| Facility | | $478.63 | $478.63 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $1,071.52
| Professional | | $346.74 | $346.74 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $380.19 / $776.25
| Facility | | $218.78 | $380.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $501.19
| Professional | | $223.87 | $295.12 | $501.19 |