- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.75 / $372.31 / $779.76
| Facility | | $323.75 | $372.31 | $779.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.76 / $268.70 / $268.70
| Professional | | $255.76 | $268.70 | $268.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.44 / $210.44 / $210.44
| Facility | | $210.44 | $210.44 | $210.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.11 / $372.11 / $465.14
| Professional | | $91.11 | $372.11 | $465.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.75 / $323.75 / $492.20
| Facility | | $323.75 | $323.75 | $492.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.04 / $135.97 / $194.25
| Professional | | $61.04 | $135.97 | $194.25 |