- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.33 / $483.74 / $536.61
| Facility | | $264.33 | $483.74 | $536.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.83 / $483.74 / $536.61
| Professional | | $208.83 | $483.74 | $536.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.71 / $327.71 / $327.71
| Facility | | $327.71 | $327.71 | $327.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.71 / $327.71 / $327.71
| Professional | | $327.71 | $327.71 | $327.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.82 / $221.65 / $359.67
| Facility | | $171.82 | $221.65 | $359.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.07 / $248.75 / $476.63
| Professional | | $113.07 | $248.75 | $476.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.60 / $240.76 / $528.67
| Professional | | $158.60 | $240.76 | $528.67 |