- 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
- $214.37 / $316.05 / $316.05
| Professional | | $214.37 | $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
- $178.32 / $228.75 / $269.93
| Professional | | $178.32 | $228.75 | $269.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.07 / $223.30 / $594.87
| Facility | | $175.07 | $223.30 | $594.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $115.43 / $164.90
| Professional | | $115.43 | $115.43 | $164.90 |