- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $630.96
| Facility | | $275.42 | $371.54 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $616.60
| Professional | | $275.42 | $371.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $389.05 / $1,479.11
| Facility | | $288.40 | $389.05 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $398.11 / $812.83
| Professional | | $371.54 | $398.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $2,818.38
| Facility | | $398.11 | $398.11 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $1,096.48
| Professional | | $288.40 | $288.40 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $851.14
| Facility | | $354.81 | $489.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $537.03
| Professional | | $251.19 | $354.81 | $537.03 |