- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.52 / $538.97 / $597.88
| Facility | | $294.52 | $538.97 | $597.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.67 / $538.97 / $597.88
| Professional | | $232.67 | $538.97 | $597.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.52 / $294.52 / $294.52
| Facility | | $294.52 | $294.52 | $294.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.52 / $294.52 / $294.52
| Professional | | $294.52 | $294.52 | $294.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.44 / $223.41 / $599.37
| Facility | | $191.44 | $223.41 | $599.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.07 / $308.22 / $560.39
| Professional | | $134.07 | $308.22 | $560.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.70 / $176.71 / $589.04
| Professional | | $123.70 | $176.71 | $589.04 |