- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.35 / $346.55 / $602.70
| Facility | | $301.35 | $346.55 | $602.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.05 / $346.55 / $346.55
| Professional | | $235.05 | $346.55 | $346.55 |
- 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
- $195.53 / $337.50 / $398.25
| Professional | | $195.53 | $337.50 | $398.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.96 / $244.85 / $652.28
| Facility | | $191.96 | $244.85 | $652.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $180.81
| Professional | | $126.57 | $126.57 | $180.81 |