- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.68 / $262.68 / $675.45
| Facility | | $262.68 | $262.68 | $675.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.68 / $352.74 / $352.74
| Professional | | $262.68 | $352.74 | $352.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.85 / $756.13 / $844.31
| Professional | | $564.85 | $756.13 | $844.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.17 / $431.17 / $632.98
| Professional | | $431.17 | $431.17 | $632.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.15 / $285.19 / $675.45
| Facility | | $225.15 | $285.19 | $675.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.38 / $450.30 / $750.50
| Professional | | $191.38 | $450.30 | $750.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $382.76 / $637.92
| Professional | | $157.61 | $382.76 | $637.92 |