- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.70 / $379.70 / $524.35
| Facility | | $379.70 | $379.70 | $524.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.81 / $292.31 / $379.70
| Professional | | $180.81 | $292.31 | $379.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.88 / $227.22 / $540.63
| Facility | | $195.88 | $227.22 | $540.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.22 / $271.22 / $271.22
| Facility | | $271.22 | $271.22 | $271.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $180.81 / $301.35
| Professional | | $126.57 | $180.81 | $301.35 |