- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $331.13 / $407.38
| Facility | | $288.40 | $331.13 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $436.52
| Facility | | $120.23 | $208.93 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $165.96 / $549.54
| Professional | | $112.20 | $165.96 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |