- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.62 / $200.62 / $202.90
| Facility | | $200.62 | $200.62 | $202.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.02 / $157.84 / $218.88
| Professional | | $141.02 | $157.84 | $218.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.13 / $381.87 / $520.54
| Facility | | $302.13 | $381.87 | $520.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.61 / $172.48 / $288.73
| Professional | | $146.61 | $172.48 | $288.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.18 / $199.37 / $351.16
| Professional | | $159.18 | $199.37 | $351.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.21 / $202.92 / $270.56
| Professional | | $164.21 | $202.92 | $270.56 |