- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.45 / $471.13 / $522.62
| Facility | | $257.45 | $471.13 | $522.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.39 / $471.13 / $522.62
| Professional | | $203.39 | $471.13 | $522.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.48 / $383.48 / $383.48
| Facility | | $383.48 | $383.48 | $383.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.48 / $383.48 / $383.48
| Professional | | $383.48 | $383.48 | $383.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.34 / $285.36 / $523.91
| Facility | | $167.34 | $285.36 | $523.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.21 / $318.47 / $603.94
| Professional | | $117.21 | $318.47 | $603.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $154.47 / $494.36
| Professional | | $108.13 | $154.47 | $494.36 |