- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.36 / $233.32 / $353.96
| Facility | | $173.36 | $233.32 | $353.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.32 / $283.35 / $685.15
| Professional | | $175.32 | $283.35 | $685.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.47 / $1,886.47 / $2,263.76
| Facility | | $1,886.47 | $1,886.47 | $2,263.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.63 / $192.12 / $318.56
| Professional | | $130.63 | $192.12 | $318.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.80 / $184.80 / $184.80
| Facility | | $184.80 | $184.80 | $184.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.52 / $279.27 / $502.23
| Professional | | $268.52 | $279.27 | $502.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.70 / $255.88 / $448.80
| Professional | | $204.70 | $255.88 | $448.80 |