- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.21 / $382.21 / $535.52
| Facility | | $335.21 | $382.21 | $535.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.12 / $382.21 / $382.21
| Professional | | $198.12 | $382.21 | $382.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.89 / $285.89 / $285.89
| Facility | | $285.89 | $285.89 | $285.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.05 / $341.25 / $341.25
| Professional | | $232.05 | $341.25 | $341.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.01 / $282.83 / $467.28
| Facility | | $163.01 | $282.83 | $467.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.27 / $304.76 / $360.34
| Professional | | $288.27 | $304.76 | $360.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.33 / $127.40 / $212.34
| Professional | | $105.33 | $127.40 | $212.34 |