- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $833.56
| Facility | | $416.78 | $416.78 | $833.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $416.78
| Professional | | $416.78 | $416.78 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.22 / $175.03 / $235.48
| Facility | | $144.22 | $175.03 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.17 / $224.91 / $270.43
| Professional | | $185.17 | $224.91 | $270.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.80 / $352.18 / $1,307.25
| Facility | | $327.80 | $352.18 | $1,307.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.63 / $175.07 / $250.10
| Professional | | $155.63 | $175.07 | $250.10 |