- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.36 / $335.06 / $582.72
| Facility | | $291.36 | $335.06 | $582.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.26 / $335.06 / $335.06
| Professional | | $227.26 | $335.06 | $335.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.74 / $218.30 / $257.58
| Professional | | $179.74 | $218.30 | $257.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.59 / $236.73 / $913.94
| Facility | | $185.59 | $236.73 | $913.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.68 / $129.58 / $306.58
| Professional | | $120.68 | $129.58 | $306.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.37 / $122.37 / $291.36
| Professional | | $122.37 | $122.37 | $291.36 |