- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.29 / $346.29 / $478.20
| Facility | | $346.29 | $346.29 | $478.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.90 / $266.58 / $346.29
| Professional | | $164.90 | $266.58 | $346.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $207.22 / $493.05
| Facility | | $178.64 | $207.22 | $493.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.35 / $247.35 / $247.35
| Facility | | $247.35 | $247.35 | $247.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $164.90 / $274.83
| Professional | | $115.43 | $164.90 | $274.83 |