- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.13 / $356.13 / $756.78
| Facility | | $356.13 | $356.13 | $756.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.47 / $288.47 / $288.47
| Professional | | $288.47 | $288.47 | $288.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.44 / $142.44 / $231.48
| Professional | | $142.44 | $142.44 | $231.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.13 / $356.13 / $359.69
| Professional | | $356.13 | $356.13 | $359.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.13 / $356.13 / $576.92
| Facility | | $356.13 | $356.13 | $576.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.47 / $288.47 / $356.13
| Professional | | $288.47 | $288.47 | $356.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.68 / $213.68 / $534.20
| Professional | | $213.68 | $213.68 | $534.20 |