- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.56 / $343.62 / $946.20
| Facility | | $160.56 | $343.62 | $946.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.27 / $193.79 / $270.19
| Professional | | $157.27 | $193.79 | $270.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.42 / $186.42 / $429.88
| Facility | | $186.42 | $186.42 | $429.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.42 / $186.42 / $281.52
| Professional | | $186.42 | $186.42 | $281.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.27 / $274.27 / $274.27
| Facility | | $274.27 | $274.27 | $274.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.13 / $233.13 / $282.50
| Professional | | $233.13 | $233.13 | $282.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.44 / $181.11 / $259.70
| Professional | | $136.44 | $181.11 | $259.70 |