- 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
- $127.93 / $223.20 / $440.92
| Facility | | $127.93 | $223.20 | $440.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.30 / $152.30 / $504.80
| Professional | | $112.30 | $152.30 | $504.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.13 / $493.79 / $670.71
| Facility | | $445.13 | $493.79 | $670.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.67 / $852.67 / $852.67
| Professional | | $852.67 | $852.67 | $852.67 |