- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.80 / $331.34 / $563.28
| Facility | | $306.80 | $331.34 | $563.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.38 / $333.38 / $333.38
| Professional | | $333.38 | $333.38 | $333.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.20 / $291.20 / $308.68
| Facility | | $291.20 | $291.20 | $308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Professional | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.45 / $331.34 / $473.82
| Facility | | $241.45 | $331.34 | $473.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.94 / $306.80 / $308.68
| Professional | | $293.94 | $306.80 | $308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.94 / $308.68 / $327.20
| Professional | | $293.94 | $308.68 | $327.20 |