- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $1,071.52
| Facility | | $257.04 | $389.05 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $426.58
| Professional | | $144.54 | $251.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $831.76
| Facility | | $281.84 | $407.38 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $398.11
| Professional | | $138.04 | $218.78 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $158.49 / $245.47
| Facility | | $104.71 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $575.44
| Professional | | $407.38 | $575.44 | $575.44 |