- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.52 / $199.52 / $513.04
| Facility | | $199.52 | $199.52 | $513.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.52 / $199.52 / $267.93
| Professional | | $199.52 | $199.52 | $267.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.85 / $574.34 / $644.53
| Professional | | $473.85 | $574.34 | $644.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.51 / $330.78 / $415.94
| Professional | | $327.51 | $330.78 | $415.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.52 / $339.18 / $1,353.89
| Facility | | $199.52 | $339.18 | $1,353.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.78 / $142.52 / $484.55
| Professional | | $70.78 | $142.52 | $484.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.78 / $119.71 / $399.04
| Professional | | $70.78 | $119.71 | $399.04 |