- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $602.56
| Facility | | $181.97 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $104.71 / $288.40
| Professional | | $33.11 | $104.71 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $245.47 / $478.63
| Facility | | $194.98 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $102.33 / $257.04
| Professional | | $33.11 | $102.33 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $85.11 / $169.82
| Facility | | $23.44 | $85.11 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $323.59 / $323.59
| Professional | | $151.36 | $323.59 | $323.59 |