- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.86 / $295.77 / $500.13
| Facility | | $204.86 | $295.77 | $500.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.42 / $312.58 / $371.62
| Professional | | $308.42 | $312.58 | $371.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.10 / $416.78 / $475.13
| Professional | | $375.10 | $416.78 | $475.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.40 / $328.91 / $1,024.52
| Professional | | $228.40 | $328.91 | $1,024.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $500.14 / $795.22
| Professional | | $416.78 | $500.14 | $795.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $240.12 / $375.10
| Professional | | $175.05 | $240.12 | $375.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.39 / $409.07 / $409.07
| Professional | | $208.39 | $409.07 | $409.07 |