- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.06 / $228.97 / $248.50
| Facility | | $211.06 | $228.97 | $248.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.08 / $224.18 / $273.64
| Professional | | $206.08 | $224.18 | $273.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.36 / $57.81 / $59.81
| Facility | | $33.36 | $57.81 | $59.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.31 / $207.49 / $209.46
| Professional | | $53.31 | $207.49 | $209.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.75 / $866.37 / $1,565.31
| Facility | | $679.75 | $866.37 | $1,565.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.81 / $65.81 / $65.81
| Professional | | $65.81 | $65.81 | $65.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.49 / $207.49 / $207.49
| Professional | | $207.49 | $207.49 | $207.49 |