- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.33 / $148.72 / $258.66
| Facility | | $129.33 | $148.72 | $258.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.26 / $148.72 / $148.72
| Professional | | $142.26 | $148.72 | $148.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.09 / $52.30 / $70.36
| Facility | | $43.09 | $52.30 | $70.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.77 / $78.67 / $83.92
| Professional | | $64.77 | $78.67 | $83.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.08 / $105.08 / $405.63
| Facility | | $82.08 | $105.08 | $405.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.57 / $61.11 / $185.85
| Professional | | $42.57 | $61.11 | $185.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.03 / $54.32 / $109.60
| Professional | | $46.03 | $54.32 | $109.60 |