- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $593.98 / $658.90
| Facility | | $324.58 | $593.98 | $658.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.42 / $593.98 / $658.90
| Professional | | $256.42 | $593.98 | $658.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.88 / $339.88 / $339.88
| Facility | | $339.88 | $339.88 | $339.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.88 / $339.88 / $339.88
| Professional | | $339.88 | $339.88 | $339.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.98 / $246.21 / $492.29
| Facility | | $210.98 | $246.21 | $492.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.86 / $256.85 / $555.45
| Professional | | $138.86 | $256.85 | $555.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $194.75 / $495.02
| Professional | | $136.32 | $194.75 | $495.02 |