- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.41 / $147.41 / $378.49
| Facility | | $147.41 | $147.41 | $378.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.41 / $204.75 / $378.49
| Professional | | $147.41 | $204.75 | $378.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.99 / $454.99 / $454.99
| Facility | | $454.99 | $454.99 | $454.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.33 / $263.79 / $580.16
| Professional | | $261.33 | $263.79 | $580.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.54 / $274.54 / $334.96
| Facility | | $274.54 | $274.54 | $334.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $200.41 / $483.76
| Professional | | $200.41 | $200.41 | $483.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.02 / $363.99 / $591.49
| Professional | | $253.02 | $363.99 | $591.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.97 / $217.07 / $334.51
| Professional | | $169.97 | $217.07 | $334.51 |