- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.20 / $258.73 / $292.12
| Facility | | $248.20 | $258.73 | $292.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.93 / $248.20 / $325.50
| Professional | | $202.93 | $248.20 | $325.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.99 / $221.29 / $334.93
| Facility | | $132.99 | $221.29 | $334.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.48 / $264.48 / $264.48
| Facility | | $264.48 | $264.48 | $264.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.44 / $272.06 / $393.34
| Professional | | $215.44 | $272.06 | $393.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.72 / $239.42 / $411.07
| Professional | | $185.72 | $239.42 | $411.07 |