- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.45 / $268.45 / $297.60
| Facility | | $268.45 | $268.45 | $297.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.28 / $268.45 / $304.52
| Professional | | $176.28 | $268.45 | $304.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.55 / $269.85 / $434.16
| Facility | | $134.55 | $269.85 | $434.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.64 / $217.85 / $274.05
| Professional | | $193.64 | $217.85 | $274.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.69 / $149.69 / $149.69
| Professional | | $149.69 | $149.69 | $149.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.39 / $184.40 / $298.41
| Professional | | $78.39 | $184.40 | $298.41 |