- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.02 / $322.70 / $452.16
| Facility | | $283.02 | $322.70 | $452.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.75 / $201.24 / $322.70
| Professional | | $170.75 | $201.24 | $322.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.50 / $236.50 / $236.50
| Facility | | $236.50 | $236.50 | $236.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.94 / $288.14 / $288.14
| Professional | | $195.94 | $288.14 | $288.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.43 / $238.80 / $526.52
| Facility | | $156.43 | $238.80 | $526.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.65 / $231.30 / $346.67
| Professional | | $135.65 | $231.30 | $346.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.13 / $141.52 / $283.02
| Professional | | $87.13 | $141.52 | $283.02 |