- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.70 / $306.39 / $371.14
| Facility | | $275.70 | $306.39 | $371.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.05 / $306.38 / $400.91
| Professional | | $246.05 | $306.38 | $400.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.09 / $608.76 / $1,176.42
| Facility | | $525.09 | $608.76 | $1,176.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.66 / $307.66 / $424.57
| Professional | | $307.66 | $307.66 | $424.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $361.45
| Facility | | $361.45 | $361.45 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $361.45 / $423.86
| Professional | | $263.86 | $361.45 | $423.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.22 / $260.68 / $426.42
| Professional | | $208.22 | $260.68 | $426.42 |