- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $436.52 / $512.86
| Facility | | $389.05 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $831.76
| Professional | | $512.86 | $512.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Professional | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $204.17 / $288.40
| Facility | | $97.72 | $204.17 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $758.58
| Facility | | $512.86 | $512.86 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $169.82 / $223.87
| Facility | | $109.65 | $169.82 | $223.87 |