- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.71 / $334.44 / $804.55
| Facility | | $235.71 | $334.44 | $804.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.52 / $180.47 / $302.08
| Professional | | $143.52 | $180.47 | $302.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.70 / $294.87 / $633.50
| Facility | | $185.70 | $294.87 | $633.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.10 / $142.10 / $267.39
| Professional | | $142.10 | $142.10 | $267.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.60 / $124.02 / $188.10
| Facility | | $94.60 | $124.02 | $188.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.69 / $405.69 / $405.69
| Professional | | $405.69 | $405.69 | $405.69 |