- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.70 / $372.70 / $514.67
| Facility | | $372.70 | $372.70 | $514.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $286.92 / $372.70
| Professional | | $177.47 | $286.92 | $372.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.20 / $443.69 / $443.69
| Professional | | $266.20 | $443.69 | $443.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.26 / $381.38 / $554.72
| Facility | | $192.26 | $381.38 | $554.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.96 / $254.81 / $444.86
| Professional | | $120.96 | $254.81 | $444.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.23 / $177.47 / $296.22
| Professional | | $124.23 | $177.47 | $296.22 |