- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.78 / $458.93 / $509.08
| Facility | | $250.78 | $458.93 | $509.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.12 / $275.86 / $481.50
| Professional | | $198.12 | $275.86 | $481.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.92 / $534.92 / $534.92
| Facility | | $534.92 | $534.92 | $534.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.92 / $534.92 / $534.92
| Professional | | $534.92 | $534.92 | $534.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.01 / $172.53 / $316.76
| Facility | | $163.01 | $172.53 | $316.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.23 / $288.27 / $360.34
| Professional | | $114.23 | $288.27 | $360.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.33 / $127.40 / $376.17
| Professional | | $105.33 | $127.40 | $376.17 |