- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.49 / $259.39 / $420.56
| Facility | | $220.49 | $259.39 | $420.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.41 / $230.68 / $1,328.36
| Professional | | $138.41 | $230.68 | $1,328.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.11 / $279.01 / $431.73
| Facility | | $185.11 | $279.01 | $431.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.26 / $253.72 / $431.73
| Professional | | $210.26 | $253.72 | $431.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.87 / $245.52 / $327.36
| Professional | | $126.87 | $245.52 | $327.36 |