- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.25 / $324.37 / $359.82
| Facility | | $177.25 | $324.37 | $359.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.03 / $324.37 / $359.82
| Professional | | $140.03 | $324.37 | $359.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.41 / $254.41 / $254.41
| Facility | | $254.41 | $254.41 | $254.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.41 / $254.41 / $254.41
| Professional | | $254.41 | $254.41 | $254.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.21 / $134.44 / $360.72
| Facility | | $115.21 | $134.44 | $360.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.68 / $185.54 / $337.35
| Professional | | $80.68 | $185.54 | $337.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.45 / $120.91 / $362.72
| Professional | | $74.45 | $120.91 | $362.72 |