- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.41 / $263.74 / $344.79
| Facility | | $241.41 | $263.74 | $344.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.61 / $263.74 / $263.74
| Professional | | $108.61 | $263.74 | $263.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.62 / $238.62 / $238.62
| Facility | | $238.62 | $238.62 | $238.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.92 / $261.64 / $261.64
| Professional | | $177.92 | $261.64 | $261.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.80 / $162.04 / $350.57
| Facility | | $120.80 | $162.04 | $350.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.25 / $167.86 / $300.45
| Professional | | $72.25 | $167.86 | $300.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.91 / $110.63 / $210.57
| Professional | | $87.91 | $110.63 | $210.57 |