- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.40 / $177.49 / $209.27
| Facility | | $157.40 | $177.49 | $209.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.63 / $165.36 / $239.42
| Professional | | $138.63 | $165.36 | $239.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.65 / $262.27 / $405.22
| Facility | | $222.65 | $262.27 | $405.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.05 / $239.42 / $328.83
| Professional | | $236.05 | $239.42 | $328.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.10 / $278.10 / $278.10
| Facility | | $278.10 | $278.10 | $278.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.01 / $265.94 / $286.44
| Professional | | $203.01 | $265.94 | $286.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.72 / $203.47 / $310.39
| Professional | | $139.72 | $203.47 | $310.39 |