- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.24 / $338.03 / $813.17
| Facility | | $238.24 | $338.03 | $813.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.19 / $116.74 / $134.78
| Professional | | $107.19 | $116.74 | $134.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.77 / $308.47 / $640.29
| Facility | | $193.77 | $308.47 | $640.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.13 / $106.13 / $106.13
| Professional | | $106.13 | $106.13 | $106.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.38 / $420.38 / $420.38
| Facility | | $420.38 | $420.38 | $420.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.55 / $583.55 / $583.55
| Professional | | $583.55 | $583.55 | $583.55 |