- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,445.44 / $2,137.96
| Facility | | $426.58 | $1,445.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $524.81
| Professional | | $371.54 | $426.58 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $316.23 / $316.23
| Facility | | $158.49 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $3.98 / $4.57
| Professional | | $3.39 | $3.98 | $4.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $239.88
| Facility | | $173.78 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $416.87
| Facility | | $204.17 | $204.17 | $416.87 |