- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $602.56
| Facility | | $275.42 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $602.56
| Professional | | $269.15 | $354.81 | $602.56 |
- 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
- $363.08 / $380.19 / $831.76
| Professional | | $363.08 | $380.19 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $2,691.53
| Facility | | $467.74 | $467.74 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $1,047.13
| Professional | | $338.84 | $338.84 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $467.74 / $851.14
| Facility | | $380.19 | $467.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $524.81
| Professional | | $251.19 | $346.74 | $524.81 |