- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.78 / $341.78 / $512.66
| Facility | | $341.78 | $341.78 | $512.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.43 / $341.78 / $369.44
| Professional | | $336.43 | $341.78 | $369.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.06 / $162.06 / $162.06
| Facility | | $162.06 | $162.06 | $162.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.47 / $81.01 / $242.55
| Facility | | $37.47 | $81.01 | $242.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.50 / $168.50 / $210.63
| Professional | | $168.50 | $168.50 | $210.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.26 / $130.26 / $130.26
| Facility | | $130.26 | $130.26 | $130.26 |