- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.88 / $325.31 / $565.76
| Facility | | $282.88 | $325.31 | $565.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.65 / $325.31 / $325.31
| Professional | | $220.65 | $325.31 | $325.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.55 / $507.38 / $598.71
| Professional | | $183.55 | $507.38 | $598.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.48 / $239.03 / $887.24
| Facility | | $222.48 | $239.03 | $887.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $118.81 / $169.73
| Professional | | $118.81 | $118.81 | $169.73 |