- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.64 / $200.29 / $230.36
| Facility | | $199.64 | $200.29 | $230.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.76 / $199.64 / $273.06
| Professional | | $158.76 | $199.64 | $273.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.75 / $410.32 / $711.50
| Facility | | $355.75 | $410.32 | $711.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.74 / $214.69 / $322.22
| Professional | | $202.74 | $214.69 | $322.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.68 / $271.68 / $271.68
| Facility | | $271.68 | $271.68 | $271.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.33 / $266.89 / $289.63
| Professional | | $198.33 | $266.89 | $289.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.69 / $189.47 / $279.02
| Professional | | $149.69 | $189.47 | $279.02 |