- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.61 / $669.56 / $945.85
| Facility | | $228.61 | $669.56 | $945.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.51 / $229.43 / $239.67
| Professional | | $190.51 | $229.43 | $239.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.96 / $231.71 / $305.74
| Professional | | $205.96 | $231.71 | $305.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.12 / $203.23 / $632.58
| Professional | | $141.12 | $203.23 | $632.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.45 / $308.94 / $491.21
| Professional | | $257.45 | $308.94 | $491.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $151.07 / $231.71
| Professional | | $108.13 | $151.07 | $231.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $252.68 / $252.68
| Professional | | $128.72 | $252.68 | $252.68 |