- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.34 / $584.34 / $806.94
| Facility | | $584.34 | $584.34 | $806.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.26 / $584.34 / $584.34
| Professional | | $278.26 | $584.34 | $584.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.44 / $349.67 / $831.97
| Facility | | $301.44 | $349.67 | $831.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.17 / $533.17 / $666.48
| Professional | | $533.17 | $533.17 | $666.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.38 / $417.38 / $417.38
| Facility | | $417.38 | $417.38 | $417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.78 / $278.26 / $463.76
| Professional | | $194.78 | $278.26 | $463.76 |