- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $269.15 / $512.86
| Facility | | $199.53 | $269.15 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $269.15 / $851.14
| Professional | | $95.50 | $269.15 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $645.65
| Professional | | $416.87 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $416.87
| Professional | | $331.13 | $331.13 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $338.84 / $1,348.96
| Facility | | $199.53 | $338.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $141.25 / $489.78
| Professional | | $70.79 | $141.25 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $165.96 / $416.87
| Professional | | $70.79 | $165.96 | $416.87 |