- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $489.78 / $870.96
| Facility | | $251.19 | $489.78 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $426.58 / $912.01
| Professional | | $169.82 | $426.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $691.83 / $1,621.81
| Facility | | $398.11 | $691.83 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $467.74 / $812.83
| Professional | | $446.68 | $467.74 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,202.26 / $2,344.23
| Facility | | $467.74 | $1,202.26 | $2,344.23 |