- 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
- $57.67 / $69.98 / $94.15
| Facility | | $57.67 | $69.98 | $94.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.71 / $228.75 / $269.93
| Professional | | $169.71 | $228.75 | $269.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.88 / $244.85 / $652.28
| Facility | | $195.88 | $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 |