- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.61 / $178.98 / $196.23
| Facility | | $176.61 | $178.98 | $196.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.53 / $177.56 / $215.42
| Professional | | $146.53 | $177.56 | $215.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.36 / $358.98 / $670.72
| Facility | | $335.36 | $358.98 | $670.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.63 / $183.63 / $422.62
| Professional | | $183.63 | $183.63 | $422.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.25 / $192.25 / $192.25
| Facility | | $192.25 | $192.25 | $192.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.34 / $192.25 / $198.02
| Professional | | $140.34 | $192.25 | $198.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.17 / $167.30 / $259.61
| Professional | | $127.17 | $167.30 | $259.61 |