- 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
- $124.47 / $285.50 / $424.46
| Facility | | $124.47 | $285.50 | $424.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.40 / $536.40 / $616.90
| Professional | | $536.40 | $536.40 | $616.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.87 / $336.20 / $627.09
| Facility | | $210.87 | $336.20 | $627.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,261.94 / $1,261.94 / $1,261.94
| Professional | | $1,261.94 | $1,261.94 | $1,261.94 |