- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.14 / $310.62 / $428.95
| Facility | | $247.14 | $310.62 | $428.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.10 / $239.12 / $310.62
| Professional | | $149.10 | $239.12 | $310.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.02 / $281.02 / $281.02
| Facility | | $281.02 | $281.02 | $281.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.54 / $308.14 / $308.14
| Professional | | $209.54 | $308.14 | $308.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.63 / $208.52 / $459.21
| Facility | | $160.63 | $208.52 | $459.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.45 / $224.43 / $370.54
| Professional | | $118.45 | $224.43 | $370.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $147.91 / $247.14
| Professional | | $103.54 | $147.91 | $247.14 |