- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.86 / $528.84 / $919.72
| Facility | | $459.86 | $528.84 | $919.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.41 / $579.41 / $579.41
| Professional | | $579.41 | $579.41 | $579.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.71 / $5.33 / $298.38
| Professional | | $2.71 | $5.33 | $298.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.68 / $388.58 / $1,441.77
| Facility | | $361.68 | $388.58 | $1,441.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.64 / $528.64 / $660.80
| Professional | | $528.64 | $528.64 | $660.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.14 / $193.14 / $459.86
| Professional | | $193.14 | $193.14 | $459.86 |