- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.09 / $248.57 / $338.15
| Facility | | $231.09 | $248.57 | $338.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.58 / $242.86 / $315.60
| Professional | | $180.58 | $242.86 | $315.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.12 / $270.12 / $563.25
| Facility | | $270.12 | $270.12 | $563.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.86 / $270.12 / $458.97
| Professional | | $242.86 | $270.12 | $458.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.68 / $252.68 / $252.68
| Facility | | $252.68 | $252.68 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.10 / $194.10 / $260.26
| Professional | | $194.10 | $194.10 | $260.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.32 / $218.30 / $319.89
| Professional | | $179.32 | $218.30 | $319.89 |