- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.98 / $588.98 / $588.98
| Facility | | $588.98 | $588.98 | $588.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.58 / $514.58 / $588.98
| Professional | | $514.58 | $514.58 | $588.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.33 / $2,142.60 / $3,491.34
| Facility | | $584.33 | $2,142.60 | $3,491.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.98 / $526.98 / $526.98
| Facility | | $526.98 | $526.98 | $526.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.98 / $526.98 / $526.98
| Professional | | $526.98 | $526.98 | $526.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $1,500.00
| Professional | | $60.00 | $85.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.98 / $526.98 / $563.41
| Facility | | $526.98 | $526.98 | $563.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.98 / $526.98 / $526.98
| Professional | | $526.98 | $526.98 | $526.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.65 / $516.65 / $516.65
| Professional | | $516.65 | $516.65 | $516.65 |