- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $331.13 / $776.25
| Facility | | $223.87 | $331.13 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $165.96 / $275.42
| Professional | | $131.83 | $165.96 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $616.60
| Facility | | $251.19 | $316.23 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $204.17
| Professional | | $131.83 | $131.83 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $269.15 / $371.54
| Facility | | $141.25 | $269.15 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |