- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.13 / $409.55 / $712.26
| Facility | | $356.13 | $409.55 | $712.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.77 / $302.70 / $302.70
| Professional | | $277.77 | $302.70 | $302.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.22 / $175.03 / $235.48
| Facility | | $144.22 | $175.03 | $235.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.07 / $426.01 / $502.69
| Professional | | $231.07 | $426.01 | $502.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.85 / $289.35 / $770.83
| Facility | | $226.85 | $289.35 | $770.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.57 / $149.57 / $356.13
| Professional | | $149.57 | $149.57 | $356.13 |