- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.45 / $343.45 / $762.92
| Facility | | $343.45 | $343.45 | $762.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.45 / $343.45 / $343.45
| Professional | | $343.45 | $343.45 | $343.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.32 / $187.52 / $587.74
| Facility | | $182.32 | $187.52 | $587.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.61 / $220.79 / $390.01
| Professional | | $132.61 | $220.79 | $390.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.30 / $245.30 / $863.87
| Facility | | $213.30 | $245.30 | $863.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.72 / $198.53 / $255.76
| Professional | | $157.72 | $198.53 | $255.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.72 / $89.59 / $127.98
| Professional | | $63.72 | $89.59 | $127.98 |