- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.52 / $309.52 / $366.58
| Facility | | $309.52 | $309.52 | $366.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.07 / $303.31 / $422.36
| Professional | | $251.07 | $303.31 | $422.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.59 / $646.63 / $1,106.31
| Facility | | $568.59 | $646.63 | $1,106.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.87 / $319.70 / $441.19
| Professional | | $307.87 | $319.70 | $441.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.44 / $328.44 / $353.54
| Facility | | $328.44 | $328.44 | $353.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.76 / $328.44 / $350.14
| Professional | | $239.76 | $328.44 | $350.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.81 / $285.14 / $459.83
| Professional | | $211.81 | $285.14 | $459.83 |