- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.65 / $308.73 / $592.25
| Facility | | $168.65 | $308.73 | $592.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.46 / $84.46 / $107.26
| Professional | | $84.46 | $84.46 | $107.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.31 / $126.69 / $208.94
| Facility | | $121.31 | $126.69 | $208.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.08 / $77.25 / $196.09
| Professional | | $54.08 | $77.25 | $196.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.31 / $244.44 / $429.70
| Facility | | $103.31 | $244.44 | $429.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.56 / $113.84 / $147.65
| Professional | | $66.56 | $113.84 | $147.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.26 / $86.31 / $164.80
| Professional | | $43.26 | $86.31 | $164.80 |