- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.98 / $270.98 / $281.33
| Facility | | $270.98 | $270.98 | $281.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.12 / $193.09 / $230.02
| Professional | | $186.12 | $193.09 | $230.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.71 / $257.45 / $329.54
| Professional | | $231.71 | $257.45 | $329.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.12 / $198.24 / $632.58
| Professional | | $141.12 | $198.24 | $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 / $148.63 / $234.27
| Professional | | $108.13 | $148.63 | $234.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $252.68 / $252.68
| Professional | | $128.72 | $252.68 | $252.68 |