- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.64 / $320.64 / $320.64
| Facility | | $320.64 | $320.64 | $320.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.64 / $408.78 / $408.78
| Professional | | $320.64 | $408.78 | $408.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.07 / $487.21 / $499.33
| Professional | | $412.07 | $487.21 | $499.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.88 / $571.53 / $718.66
| Professional | | $565.88 | $571.53 | $718.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.55 / $408.78 / $2,274.39
| Facility | | $226.55 | $408.78 | $2,274.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.58 / $329.81 / $366.45
| Professional | | $175.58 | $329.81 | $366.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.58 / $219.87 / $366.45
| Professional | | $146.58 | $219.87 | $366.45 |