- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.25 / $258.45 / $713.43
| Facility | | $133.25 | $258.45 | $713.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.56 / $89.59 / $100.57
| Professional | | $84.56 | $89.59 | $100.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.48 / $635.48 / $635.48
| Facility | | $635.48 | $635.48 | $635.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.50 / $104.45 / $152.16
| Professional | | $81.50 | $104.45 | $152.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.35 / $115.35 / $1,087.83
| Facility | | $115.35 | $115.35 | $1,087.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.09 / $154.35 / $239.40
| Professional | | $91.09 | $154.35 | $239.40 |