- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.68 / $376.68 / $588.57
| Facility | | $376.68 | $376.68 | $588.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.60 / $588.57 / $594.23
| Professional | | $353.60 | $588.57 | $594.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.87 / $520.87 / $520.87
| Facility | | $520.87 | $520.87 | $520.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.87 / $520.87 / $520.87
| Professional | | $520.87 | $520.87 | $520.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.01 / $420.01 / $420.01
| Facility | | $420.01 | $420.01 | $420.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.61 / $306.61 / $420.01
| Professional | | $306.61 | $306.61 | $420.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.56 / $348.55 / $530.95
| Professional | | $223.56 | $348.55 | $530.95 |