- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.74 / $253.85 / $441.48
| Facility | | $220.74 | $253.85 | $441.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.18 / $253.85 / $253.85
| Professional | | $172.18 | $253.85 | $253.85 |
- 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
- $153.47 / $225.53 / $266.13
| Professional | | $153.47 | $225.53 | $266.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.37 / $190.22 / $692.13
| Facility | | $162.37 | $190.22 | $692.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.48 / $169.73 / $1,231.70
| Professional | | $97.48 | $169.73 | $1,231.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.71 / $92.71 / $180.69
| Professional | | $92.71 | $92.71 | $180.69 |