- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.51 / $270.51 / $473.39
| Facility | | $270.51 | $270.51 | $473.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.74 / $270.51 / $270.51
| Professional | | $260.74 | $270.51 | $270.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.44 / $316.44 / $316.44
| Professional | | $316.44 | $316.44 | $316.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.02 / $277.02 / $277.02
| Facility | | $277.02 | $277.02 | $277.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.02 / $277.02 / $277.02
| Professional | | $277.02 | $277.02 | $277.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.62 / $1,399.65 / $1,399.65
| Facility | | $309.62 | $1,399.65 | $1,399.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.60 / $271.60 / $277.02
| Professional | | $271.60 | $271.60 | $277.02 |