- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.13 / $245.46 / $331.37
| Facility | | $134.13 | $245.46 | $331.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.96 / $105.96 / $154.25
| Professional | | $105.96 | $105.96 | $154.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.37 / $181.08 / $181.08
| Facility | | $174.37 | $181.08 | $181.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.08 / $181.08 / $181.08
| Professional | | $181.08 | $181.08 | $181.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.72 / $120.72 / $134.13
| Facility | | $120.72 | $120.72 | $134.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $80.48 / $228.02
| Professional | | $56.33 | $80.48 | $228.02 |