- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.80 / $192.29 / $220.31
| Facility | | $178.80 | $192.29 | $220.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.80 / $220.31 / $311.70
| Professional | | $178.80 | $220.31 | $311.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.20 / $327.20 / $327.20
| Facility | | $327.20 | $327.20 | $327.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.86 / $238.86 / $327.20
| Professional | | $238.86 | $238.86 | $327.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99,999.99 / $99,999.99 / $99,999.99
| Facility | | $99,999.99 | $99,999.99 | $99,999.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.84 / $314.73 / $418.79
| Professional | | $188.84 | $314.73 | $418.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.07 / $278.57 / $306.42
| Professional | | $181.07 | $278.57 | $306.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.84 / $276.08 / $314.79
| Facility | | $166.84 | $276.08 | $314.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.84 / $208.93 / $314.79
| Professional | | $179.84 | $208.93 | $314.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.57 / $278.57 / $278.57
| Professional | | $278.57 | $278.57 | $278.57 |