- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.94 / $193.25 / $463.80
| Facility | | $144.94 | $193.25 | $463.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.01 / $143.01 / $206.78
| Professional | | $143.01 | $143.01 | $206.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.61 / $125.61 / $516.26
| Facility | | $125.61 | $125.61 | $516.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $103.12 / $281.66
| Professional | | $80.70 | $103.12 | $281.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.01 / $193.25 / $324.66
| Facility | | $143.01 | $193.25 | $324.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.17 / $81.17 / $289.88
| Professional | | $81.17 | $81.17 | $289.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.17 / $81.17 / $123.68
| Professional | | $81.17 | $81.17 | $123.68 |