- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.00 / $472.18 / $873.22
| Facility | | $304.00 | $472.18 | $873.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.35 / $317.60 / $317.60
| Professional | | $212.35 | $317.60 | $317.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.85 / $326.86 / $464.37
| Facility | | $186.85 | $326.86 | $464.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.35 / $269.35 / $269.35
| Facility | | $269.35 | $269.35 | $269.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.32 / $230.32 / $230.32
| Facility | | $230.32 | $230.32 | $230.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.76 / $116.76 / $148.66
| Professional | | $116.76 | $116.76 | $148.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.47 / $137.37 / $140.19
| Professional | | $128.47 | $137.37 | $140.19 |