- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.48 / $341.44 / $391.19
| Facility | | $317.48 | $341.44 | $391.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.47 / $391.19 / $553.48
| Professional | | $318.47 | $391.19 | $553.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.41 / $530.41 / $530.41
| Facility | | $530.41 | $530.41 | $530.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.20 / $387.20 / $519.00
| Professional | | $387.20 | $387.20 | $519.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.60 / $99,999.99 / $99,999.99
| Facility | | $257.60 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.30 / $522.60 / $743.63
| Professional | | $335.30 | $522.60 | $743.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.10 / $398.63 / $438.49
| Professional | | $259.10 | $398.63 | $438.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.33 / $370.99 / $558.96
| Professional | | $319.33 | $370.99 | $558.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.63 / $398.63 / $449.98
| Professional | | $398.63 | $398.63 | $449.98 |