- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.82 / $382.70 / $591.34
| Facility | | $203.82 | $382.70 | $591.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.90 / $161.12 / $198.16
| Professional | | $138.90 | $161.12 | $198.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.50 / $231.50 / $231.50
| Professional | | $231.50 | $231.50 | $231.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.72 / $303.36 / $420.31
| Facility | | $163.72 | $303.36 | $420.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.16 / $185.20 / $249.15
| Facility | | $148.16 | $185.20 | $249.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.78 / $111.12 / $922.30
| Professional | | $77.78 | $111.12 | $922.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.78 / $111.12 / $163.77
| Professional | | $77.78 | $111.12 | $163.77 |