- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $223.87 / $398.11
| Facility | | $199.53 | $223.87 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $218.78
| Professional | | $199.53 | $199.53 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $524.81 / $870.96
| Facility | | $269.15 | $524.81 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $229.09
| Professional | | $199.53 | $199.53 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $199.53 / $199.53
| Facility | | $186.21 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $354.81
| Professional | | $186.21 | $316.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $199.53 / $223.87
| Professional | | $194.98 | $199.53 | $223.87 |