- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.72 / $448.72 / $619.66
| Facility | | $448.72 | $448.72 | $619.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.68 / $448.72 / $448.72
| Professional | | $213.68 | $448.72 | $448.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.48 / $268.52 / $638.88
| Facility | | $231.48 | $268.52 | $638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.52 / $320.52 / $320.52
| Facility | | $320.52 | $320.52 | $320.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.57 / $213.68 / $356.13
| Professional | | $149.57 | $213.68 | $356.13 |