- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $553.79 / $614.32
| Facility | | $302.62 | $553.79 | $614.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.07 / $553.79 / $614.32
| Professional | | $239.07 | $553.79 | $614.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $302.62
| Facility | | $302.62 | $302.62 | $302.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $302.62
| Professional | | $302.62 | $302.62 | $302.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.28 / $84.97 / $253.74
| Facility | | $46.28 | $84.97 | $253.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.34 / $112.84 / $362.87
| Professional | | $44.34 | $112.84 | $362.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $302.62 / $302.62
| Facility | | $302.62 | $302.62 | $302.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.86 / $127.10 / $181.57
| Professional | | $24.86 | $127.10 | $181.57 |