- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.73 / $198.64 / $345.46
| Facility | | $172.73 | $198.64 | $345.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.72 / $198.64 / $198.64
| Professional | | $134.72 | $198.64 | $198.64 |
- 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
- $103.82 / $152.56 / $180.02
| Professional | | $103.82 | $152.56 | $180.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.27 / $140.34 / $542.20
| Facility | | $112.27 | $140.34 | $542.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.37 / $114.81 / $832.86
| Professional | | $76.37 | $114.81 | $832.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.55 / $85.43 / $122.05
| Professional | | $72.55 | $85.43 | $122.05 |