- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.37 / $362.83 / $415.70
| Facility | | $337.37 | $362.83 | $415.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.37 / $415.70 / $588.14
| Professional | | $337.37 | $415.70 | $588.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.44 / $589.44 / $589.44
| Facility | | $589.44 | $589.44 | $589.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.29 / $430.29 / $589.44
| Professional | | $430.29 | $430.29 | $589.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.83 / $99,999.99 / $99,999.99
| Facility | | $273.83 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.31 / $555.32 / $790.21
| Professional | | $356.31 | $555.32 | $790.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.48 / $226.90 / $249.59
| Professional | | $147.48 | $226.90 | $249.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.34 / $394.23 / $593.98
| Professional | | $339.34 | $394.23 | $593.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.90 / $226.90 / $478.16
| Professional | | $226.90 | $226.90 | $478.16 |