- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $281.84 / $346.74
| Facility | | $275.42 | $281.84 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $79.43 / $102.33
| Professional | | $64.57 | $79.43 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $165.96
| Professional | | $131.83 | $131.83 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $85.11 / $125.89
| Facility | | $56.23 | $85.11 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $39.81 / $51.29
| Professional | | $36.31 | $39.81 | $51.29 |