- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.48 / $166.48 / $176.27
| Facility | | $166.48 | $166.48 | $176.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.74 / $147.28 / $209.71
| Professional | | $111.74 | $147.28 | $209.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.60 / $250.09 / $383.77
| Facility | | $246.60 | $250.09 | $383.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.42 / $202.08 / $248.07
| Professional | | $188.42 | $202.08 | $248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.31 / $166.31 / $218.29
| Facility | | $166.31 | $166.31 | $218.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.36 / $166.31 / $281.54
| Professional | | $141.36 | $166.31 | $281.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.39 / $148.94 / $245.33
| Professional | | $106.39 | $148.94 | $245.33 |