- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.56 / $297.41 / $715.47
| Facility | | $190.56 | $297.41 | $715.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.77 / $236.12 / $358.25
| Professional | | $155.77 | $236.12 | $358.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.14 / $271.41 / $563.36
| Facility | | $165.14 | $271.41 | $563.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.03 / $216.61 / $323.70
| Professional | | $141.03 | $216.61 | $323.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.78 / $237.78 / $237.78
| Facility | | $237.78 | $237.78 | $237.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.32 / $541.32 / $541.32
| Professional | | $541.32 | $541.32 | $541.32 |