- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.61 / $226.61 / $354.08
| Facility | | $226.61 | $226.61 | $354.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.75 / $329.50 / $451.60
| Professional | | $224.75 | $329.50 | $451.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.19 / $322.19 / $322.19
| Professional | | $322.19 | $322.19 | $322.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.68 / $252.68 / $252.68
| Facility | | $252.68 | $252.68 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.10 / $194.10 / $252.68
| Professional | | $194.10 | $194.10 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.49 / $201.73 / $310.86
| Professional | | $134.49 | $201.73 | $310.86 |