- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.73 / $244.73 / $629.32
| Facility | | $244.73 | $244.73 | $629.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.73 / $244.73 / $244.73
| Professional | | $244.73 | $244.73 | $244.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.27 / $704.48 / $786.65
| Professional | | $526.27 | $704.48 | $786.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.85 / $401.85 / $589.92
| Professional | | $401.85 | $401.85 | $589.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.77 / $265.70 / $629.32
| Facility | | $209.77 | $265.70 | $629.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.31 / $419.54 / $699.24
| Professional | | $178.31 | $419.54 | $699.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.62 / $349.62 / $349.62
| Facility | | $349.62 | $349.62 | $349.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $178.31 / $506.95
| Professional | | $146.84 | $178.31 | $506.95 |