- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.87 / $228.51 / $253.49
| Facility | | $124.87 | $228.51 | $253.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.65 / $228.51 / $253.49
| Professional | | $98.65 | $228.51 | $253.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.38 / $148.38 / $148.38
| Facility | | $148.38 | $148.38 | $148.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.38 / $148.38 / $148.38
| Professional | | $148.38 | $148.38 | $148.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.17 / $85.23 / $104.71
| Facility | | $81.17 | $85.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.44 / $97.33 / $211.41
| Professional | | $53.44 | $97.33 | $211.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.45 / $74.92 / $187.31
| Professional | | $52.45 | $74.92 | $187.31 |