- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.96 / $188.55 / $327.92
| Facility | | $163.96 | $188.55 | $327.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.89 / $188.55 / $188.55
| Professional | | $127.89 | $188.55 | $188.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.98 / $81.98 / $81.98
| Professional | | $81.98 | $81.98 | $81.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.88 / $167.35 / $197.47
| Professional | | $113.88 | $167.35 | $197.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.60 / $141.28 / $514.48
| Facility | | $120.60 | $141.28 | $514.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.45 / $126.07 / $914.99
| Professional | | $72.45 | $126.07 | $914.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.56 / $163.96 / $200.82
| Facility | | $147.56 | $163.96 | $200.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.86 / $93.95 / $223.69
| Professional | | $68.86 | $93.95 | $223.69 |