- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.52 / $283.50 / $493.04
| Facility | | $246.52 | $283.50 | $493.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.29 / $283.50 / $283.50
| Professional | | $192.29 | $283.50 | $283.50 |
- 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
- $168.17 / $246.52 / $290.89
| Professional | | $168.17 | $246.52 | $290.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.10 / $200.30 / $773.26
| Facility | | $156.10 | $200.30 | $773.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.78 / $139.28 / $1,010.29
| Professional | | $106.78 | $139.28 | $1,010.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $103.80 / $148.28
| Professional | | $103.54 | $103.80 | $148.28 |