- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $363.08
| Facility | | $218.78 | $309.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $363.08
| Professional | | $32.36 | $44.67 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $208.93 / $295.12
| Professional | | $141.25 | $208.93 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $51.29 / $154.88
| Facility | | $38.02 | $51.29 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $199.53 / $302.00
| Professional | | $125.89 | $199.53 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $50.12 / $70.79
| Professional | | $39.81 | $50.12 | $70.79 |