- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.46 / $234.46 / $366.34
| Facility | | $234.46 | $234.46 | $366.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.54 / $340.91 / $467.24
| Professional | | $232.54 | $340.91 | $467.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.20 / $324.20 / $324.20
| Facility | | $324.20 | $324.20 | $324.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.20 / $324.20 / $324.20
| Professional | | $324.20 | $324.20 | $324.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.86 / $360.86 / $360.86
| Facility | | $360.86 | $360.86 | $360.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.43 / $263.43 / $360.86
| Professional | | $263.43 | $263.43 | $360.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.15 / $208.72 / $321.63
| Professional | | $139.15 | $208.72 | $321.63 |