- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.28 / $221.28 / $225.82
| Facility | | $221.28 | $221.28 | $225.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.99 / $212.77 / $284.04
| Professional | | $185.99 | $212.77 | $284.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.67 / $268.62 / $395.73
| Professional | | $196.67 | $268.62 | $395.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.85 / $299.14 / $406.42
| Professional | | $227.85 | $299.14 | $406.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.53 / $237.11 / $367.08
| Facility | | $200.53 | $237.11 | $367.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.61 / $288.95 / $447.57
| Professional | | $213.61 | $288.95 | $447.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.97 / $314.08 / $527.33
| Professional | | $233.97 | $314.08 | $527.33 |