- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.88 / $325.31 / $565.76
| Facility | | $282.88 | $325.31 | $565.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.65 / $325.31 / $325.31
| Professional | | $220.65 | $325.31 | $325.31 |
- 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
- $183.87 / $229.84 / $612.29
| Facility | | $183.87 | $229.84 | $612.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $118.81 / $169.73
| Professional | | $118.81 | $118.81 | $169.73 |