- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.74 / $161.63 / $589.19
| Facility | | $118.74 | $161.63 | $589.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.02 / $124.34 / $145.63
| Professional | | $84.02 | $124.34 | $145.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.30 / $218.76 / $344.71
| Facility | | $121.30 | $218.76 | $344.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.81 / $90.21 / $851.60
| Facility | | $72.81 | $90.21 | $851.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.37 / $128.44 / $160.55
| Professional | | $59.37 | $128.44 | $160.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.05 / $56.01 / $151.22
| Professional | | $47.05 | $56.01 | $151.22 |