- 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 / $237.04 / $495.90
| Facility | | $127.93 | $237.04 | $495.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.30 / $152.30 / $567.20
| Professional | | $112.30 | $152.30 | $567.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.33 / $556.14 / $748.56
| Facility | | $501.33 | $556.14 | $748.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.33 / $960.33 / $960.33
| Professional | | $960.33 | $960.33 | $960.33 |