- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $794.33
| Facility | | $524.81 | $602.56 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $407.38 / $602.56
| Professional | | $346.74 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $660.69 / $891.25
| Facility | | $549.54 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $338.84
| Professional | | $114.82 | $131.83 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $1,148.15
| Facility | | $323.59 | $426.58 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $758.58
| Professional | | $602.56 | $602.56 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $478.63 / $524.81
| Facility | | $218.78 | $478.63 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $263.03 / $524.81
| Professional | | $218.78 | $263.03 | $524.81 |