- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.05 / $373.54 / $735.40
| Facility | | $204.05 | $373.54 | $735.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.58 / $118.73 / $129.80
| Professional | | $118.58 | $118.73 | $129.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.62 / $170.32 / $252.80
| Facility | | $169.62 | $170.32 | $252.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.61 / $144.61 / $279.13
| Professional | | $144.61 | $144.61 | $279.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.52 / $297.52 / $523.02
| Facility | | $297.52 | $297.52 | $523.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.20 / $192.04 / $416.12
| Professional | | $90.20 | $192.04 | $416.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.36 / $176.54 / $254.01
| Professional | | $78.36 | $176.54 | $254.01 |