- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.52 / $307.56 / $752.56
| Facility | | $264.52 | $307.56 | $752.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.78 / $244.10 / $291.29
| Professional | | $208.78 | $244.10 | $291.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.44 / $141.44 / $141.44
| Facility | | $141.44 | $141.44 | $141.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.48 / $280.94 / $487.28
| Professional | | $210.48 | $280.94 | $487.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.42 / $617.69 / $1,235.33
| Facility | | $260.42 | $617.69 | $1,235.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.00 / $143.00 / $143.00
| Facility | | $143.00 | $143.00 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.10 / $286.91 / $640.40
| Professional | | $219.10 | $286.91 | $640.40 |