- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.43 / $468.54 / $814.86
| Facility | | $407.43 | $468.54 | $814.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.32 / $346.32 / $346.32
| Professional | | $346.32 | $346.32 | $346.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.36 / $836.82 / $987.45
| Professional | | $264.36 | $836.82 | $987.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.52 / $331.04 / $881.88
| Facility | | $259.52 | $331.04 | $881.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.12 / $171.12 / $407.43
| Professional | | $171.12 | $171.12 | $407.43 |