- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $239.88 / $275.42
| Facility | | $218.78 | $239.88 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $275.42
| Professional | | $213.80 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $331.13
| Facility | | $104.71 | $104.71 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $275.42 / $288.40
| Facility | | $104.71 | $275.42 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $257.04 / $446.68
| Facility | | $74.13 | $257.04 | $446.68 |