- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $602.56
| Facility | | $354.81 | $354.81 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $363.08 / $436.52
| Professional | | $354.81 | $363.08 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $19.05 / $31.62
| Facility | | $12.30 | $19.05 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $371.54 / $371.54
| Professional | | $19.95 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $371.54 / $660.69
| Facility | | $104.71 | $371.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $371.54 / $371.54
| Professional | | $331.13 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $407.38
| Professional | | $371.54 | $371.54 | $407.38 |