- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.57 / $216.86 / $377.14
| Facility | | $188.57 | $216.86 | $377.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.08 / $216.86 / $216.86
| Professional | | $147.08 | $216.86 | $216.86 |
- 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
- $179.14 / $269.10 / $317.54
| Professional | | $179.14 | $269.10 | $317.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.58 / $189.23 / $591.50
| Facility | | $140.58 | $189.23 | $591.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.31 / $111.83 / $1,002.96
| Professional | | $83.31 | $111.83 | $1,002.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.14 / $146.93 / $262.47
| Professional | | $113.14 | $146.93 | $262.47 |