- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.33 / $287.95 / $486.44
| Professional | | $269.33 | $287.95 | $486.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.92 / $479.92 / $492.72
| Professional | | $479.92 | $479.92 | $492.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.99 / $606.87 / $1,097.20
| Facility | | $167.99 | $606.87 | $1,097.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.99 / $559.98 / $720.98
| Professional | | $454.99 | $559.98 | $720.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.03 / $382.03 / $382.03
| Facility | | $382.03 | $382.03 | $382.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.88 / $278.88 / $697.88
| Professional | | $278.88 | $278.88 | $697.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.91 / $445.92 / $3,201.26
| Facility | | $193.91 | $445.92 | $3,201.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.47 / $300.36 / $462.84
| Professional | | $271.47 | $300.36 | $462.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.47 / $300.36 / $452.45
| Professional | | $271.47 | $300.36 | $452.45 |