- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.58 / $273.20 / $767.45
| Facility | | $177.58 | $273.20 | $767.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.20 / $286.76 / $352.78
| Professional | | $273.20 | $286.76 | $352.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.40 / $585.67 / $585.67
| Facility | | $556.40 | $585.67 | $585.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.88 / $579.88 / $579.88
| Professional | | $579.88 | $579.88 | $579.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.88 / $799.88 / $799.88
| Professional | | $799.88 | $799.88 | $799.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.20 / $286.76 / $600.79
| Facility | | $273.20 | $286.76 | $600.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.37 / $421.45 / $436.67
| Professional | | $298.37 | $421.45 | $436.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.37 / $397.95 / $436.67
| Professional | | $298.37 | $397.95 | $436.67 |