- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.75 / $303.75 / $1,128.83
| Facility | | $219.75 | $303.75 | $1,128.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.75 / $250.85 / $269.50
| Professional | | $219.75 | $250.85 | $269.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.05 / $941.57 / $1,483.64
| Facility | | $522.05 | $941.57 | $1,483.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.14 / $482.14 / $482.14
| Facility | | $482.14 | $482.14 | $482.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.62 / $504.43 / $3,405.76
| Facility | | $397.62 | $504.43 | $3,405.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $124.39 / $310.97
| Professional | | $87.07 | $124.39 | $310.97 |