- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.56 / $637.86 / $707.58
| Facility | | $348.56 | $637.86 | $707.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.36 / $637.86 / $707.58
| Professional | | $275.36 | $637.86 | $707.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.56 / $348.56 / $348.56
| Facility | | $348.56 | $348.56 | $348.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.56 / $348.56 / $348.56
| Professional | | $348.56 | $348.56 | $348.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.56 / $264.39 / $589.30
| Facility | | $226.56 | $264.39 | $589.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.21 / $307.61 / $596.85
| Professional | | $149.21 | $307.61 | $596.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.40 / $209.14 / $592.55
| Professional | | $146.40 | $209.14 | $592.55 |