- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.11 / $210.44 / $246.13
| Facility | | $205.11 | $210.44 | $246.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.33 / $213.31 / $278.24
| Professional | | $164.33 | $213.31 | $278.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.03 / $453.53 / $784.38
| Facility | | $370.03 | $453.53 | $784.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.92 / $217.64 / $315.92
| Professional | | $215.92 | $217.64 | $315.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.81 / $297.81 / $297.81
| Facility | | $297.81 | $297.81 | $297.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.40 / $279.61 / $306.74
| Professional | | $217.40 | $279.61 | $306.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.21 / $194.32 / $289.62
| Professional | | $160.21 | $194.32 | $289.62 |