- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.61 / $277.17 / $428.28
| Facility | | $147.61 | $277.17 | $428.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.60 / $116.69 / $134.13
| Professional | | $100.60 | $116.69 | $134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.81 / $136.81 / $136.81
| Professional | | $136.81 | $136.81 | $136.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.56 / $219.69 / $304.27
| Facility | | $118.56 | $219.69 | $304.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.30 / $134.13 / $180.45
| Facility | | $107.30 | $134.13 | $180.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $80.48 / $670.65
| Professional | | $56.33 | $80.48 | $670.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.29 / $134.13 / $201.20
| Facility | | $48.29 | $134.13 | $201.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $80.48 / $201.20
| Professional | | $56.33 | $80.48 | $201.20 |