- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.74 / $247.99 / $312.47
| Facility | | $243.74 | $247.99 | $312.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.57 / $257.27 / $339.46
| Professional | | $194.57 | $257.27 | $339.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.94 / $569.73 / $869.88
| Facility | | $434.94 | $569.73 | $869.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.30 / $263.39 / $380.04
| Professional | | $262.30 | $263.39 | $380.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.77 / $271.77 / $300.06
| Facility | | $271.77 | $271.77 | $300.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.39 / $271.77 / $310.14
| Professional | | $198.39 | $271.77 | $310.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.49 / $216.98 / $340.41
| Professional | | $189.49 | $216.98 | $340.41 |