- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.23 / $321.82 / $375.65
| Facility | | $283.23 | $321.82 | $375.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.85 / $185.67 / $335.43
| Facility | | $114.85 | $185.67 | $335.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.90 / $136.40 / $384.50
| Professional | | $100.90 | $136.40 | $384.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.42 / $375.38 / $627.45
| Facility | | $338.42 | $375.38 | $627.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.24 / $648.24 / $648.24
| Professional | | $648.24 | $648.24 | $648.24 |