- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.53 / $353.55 / $850.52
| Facility | | $226.53 | $353.55 | $850.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.72 / $190.78 / $327.50
| Professional | | $151.72 | $190.78 | $327.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.80 / $311.72 / $669.70
| Facility | | $181.80 | $311.72 | $669.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.22 / $177.81 / $303.25
| Professional | | $150.22 | $177.81 | $303.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.92 / $621.92 / $621.92
| Facility | | $621.92 | $621.92 | $621.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.23 / $875.23 / $875.23
| Professional | | $875.23 | $875.23 | $875.23 |