- 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
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.68 / $212.16 / $250.35
| Professional | | $174.68 | $212.16 | $250.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $223.30 / $594.87
| Facility | | $178.64 | $223.30 | $594.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $115.43 / $247.35
| Professional | | $115.43 | $115.43 | $247.35 |