- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.92 / $131.49 / $199.09
| Facility | | $84.92 | $131.49 | $199.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.92 / $131.49 / $274.95
| Professional | | $84.92 | $131.49 | $274.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.71 / $173.58 / $254.51
| Professional | | $116.71 | $173.58 | $254.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.81 / $203.98 / $326.22
| Professional | | $115.81 | $203.98 | $326.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.49 / $206.51 / $347.68
| Professional | | $131.49 | $206.51 | $347.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.09 / $199.09 / $199.09
| Facility | | $199.09 | $199.09 | $199.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.92 / $139.49 / $286.41
| Professional | | $84.92 | $139.49 | $286.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.55 / $223.11 / $339.86
| Professional | | $156.55 | $223.11 | $339.86 |