- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.46 / $275.91 / $663.75
| Facility | | $194.46 | $275.91 | $663.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.40 / $148.88 / $255.58
| Professional | | $118.40 | $148.88 | $255.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.19 / $243.27 / $522.64
| Facility | | $153.19 | $243.27 | $522.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.23 / $138.76 / $236.66
| Professional | | $117.23 | $138.76 | $236.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.32 / $127.72 / $184.20
| Facility | | $84.32 | $127.72 | $184.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.01 / $361.01 / $361.01
| Professional | | $361.01 | $361.01 | $361.01 |