- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $316.05 / $549.66
| Facility | | $274.83 | $316.05 | $549.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.54 / $316.05 / $316.05
| Professional | | $209.54 | $316.05 | $316.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.71 / $217.32 / $256.44
| Professional | | $169.71 | $217.32 | $256.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.04 / $223.30 / $594.87
| Facility | | $157.04 | $223.30 | $594.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $103.54 / $147.91
| Professional | | $103.54 | $103.54 | $147.91 |