- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.78 / $250.83 / $603.41
| Facility | | $176.78 | $250.83 | $603.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.46 / $173.33 / $302.14
| Professional | | $98.46 | $173.33 | $302.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.83 / $229.32 / $475.13
| Facility | | $152.83 | $229.32 | $475.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.49 / $152.78 / $275.50
| Professional | | $97.49 | $152.78 | $275.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.62 / $109.98 / $177.70
| Facility | | $69.62 | $109.98 | $177.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.00 / $491.77 / $491.77
| Professional | | $130.00 | $491.77 | $491.77 |