- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.74 / $403.95 / $448.10
| Facility | | $220.74 | $403.95 | $448.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.38 / $403.95 / $448.10
| Professional | | $174.38 | $403.95 | $448.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.74 / $220.74 / $220.74
| Facility | | $220.74 | $220.74 | $220.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.74 / $220.74 / $220.74
| Professional | | $220.74 | $220.74 | $220.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.47 / $167.44 / $449.24
| Facility | | $143.47 | $167.44 | $449.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.51 / $231.08 / $420.14
| Professional | | $100.51 | $231.08 | $420.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.71 / $150.58 / $430.64
| Professional | | $92.71 | $150.58 | $430.64 |