- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.48 / $370.66 / $438.37
| Facility | | $202.48 | $370.66 | $438.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.95 / $101.42 / $117.82
| Professional | | $95.95 | $101.42 | $117.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.66 / $152.13 / $250.85
| Facility | | $145.66 | $152.13 | $250.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.84 / $92.76 / $231.23
| Professional | | $78.84 | $92.76 | $231.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.22 / $295.22 / $518.98
| Facility | | $295.22 | $295.22 | $518.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.10 / $182.46 / $413.19
| Professional | | $95.10 | $182.46 | $413.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.41 / $148.41 / $148.41
| Facility | | $148.41 | $148.41 | $148.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.95 / $84.37 / $244.70
| Professional | | $51.95 | $84.37 | $244.70 |