- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.32 / $187.53 / $264.39
| Facility | | $182.32 | $187.53 | $264.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $240.84 / $286.14
| Professional | | $238.46 | $240.84 | $286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.96 / $224.96 / $238.46
| Facility | | $224.96 | $224.96 | $238.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $238.46
| Professional | | $238.46 | $238.46 | $238.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.64 / $211.91 / $4,370.81
| Facility | | $173.64 | $211.91 | $4,370.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.59 / $184.06 / $16,586.83
| Professional | | $147.59 | $184.06 | $16,586.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.54 / $238.46 / $292.35
| Professional | | $226.54 | $238.46 | $292.35 |