- 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
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.53 / $320.63 / $378.34
| Professional | | $195.53 | $320.63 | $378.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.96 / $244.85 / $944.75
| Facility | | $191.96 | $244.85 | $944.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.46 / $133.06 / $168.76
| Professional | | $130.46 | $133.06 | $168.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $126.57 / $180.81
| Professional | | $126.57 | $126.57 | $180.81 |