- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.62 / $310.62 / $478.20
| Facility | | $310.62 | $310.62 | $478.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $266.58 / $310.62
| Professional | | $147.91 | $266.58 | $310.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.33 / $371.03 / $412.25
| Professional | | $280.33 | $371.03 | $412.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.64 / $207.22 / $493.05
| Facility | | $178.64 | $207.22 | $493.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $147.91 / $247.14
| Professional | | $103.54 | $147.91 | $247.14 |