- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.52 / $451.13 / $500.44
| Facility | | $246.52 | $451.13 | $500.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.75 / $451.13 / $500.44
| Professional | | $194.75 | $451.13 | $500.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.52 / $246.52 / $246.52
| Facility | | $246.52 | $246.52 | $246.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.52 / $246.52 / $246.52
| Professional | | $246.52 | $246.52 | $246.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.24 / $187.00 / $368.67
| Facility | | $160.24 | $187.00 | $368.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.50 / $192.43 / $421.99
| Professional | | $105.50 | $192.43 | $421.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $147.91 / $420.14
| Professional | | $103.54 | $147.91 | $420.14 |