- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.38 / $613.75 / $680.82
| Facility | | $335.38 | $613.75 | $680.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.95 / $613.75 / $680.82
| Professional | | $264.95 | $613.75 | $680.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.38 / $335.38 / $335.38
| Facility | | $335.38 | $335.38 | $335.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.38 / $335.38 / $335.38
| Professional | | $335.38 | $335.38 | $335.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.00 / $254.41 / $682.53
| Facility | | $218.00 | $254.41 | $682.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.71 / $351.03 / $638.24
| Professional | | $152.71 | $351.03 | $638.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.86 / $228.77 / $686.31
| Professional | | $140.86 | $228.77 | $686.31 |