- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.94 / $217.26 / $225.34
| Facility | | $186.94 | $217.26 | $225.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.26 / $247.45 / $350.72
| Facility | | $135.26 | $247.45 | $350.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.06 / $149.77 / $170.19
| Professional | | $106.06 | $149.77 | $170.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.05 / $101.05 / $120.27
| Professional | | $101.05 | $101.05 | $120.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.25 / $505.25 / $505.25
| Facility | | $505.25 | $505.25 | $505.25 |