- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.08 / $261.52 / $264.43
| Facility | | $225.08 | $261.52 | $264.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.63 / $261.52 / $281.08
| Professional | | $144.63 | $261.52 | $281.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.41 / $353.41 / $384.51
| Facility | | $353.41 | $353.41 | $384.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.65 / $241.63 / $309.77
| Professional | | $210.65 | $241.63 | $309.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.08 / $359.13 / $722.69
| Facility | | $217.08 | $359.13 | $722.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.30 / $279.33 / $379.74
| Professional | | $183.30 | $279.33 | $379.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.09 / $213.58 / $347.65
| Professional | | $167.09 | $213.58 | $347.65 |