- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.51 / $346.80 / $384.71
| Facility | | $189.51 | $346.80 | $384.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.71 / $208.46 / $363.86
| Professional | | $149.71 | $208.46 | $363.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.51 / $189.51 / $189.51
| Facility | | $189.51 | $189.51 | $189.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.51 / $189.51 / $189.51
| Professional | | $189.51 | $189.51 | $189.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.21 / $104.52 / $143.75
| Facility | | $49.21 | $104.52 | $143.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.08 / $86.35 / $272.06
| Professional | | $31.08 | $86.35 | $272.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.92 / $79.59 / $162.97
| Professional | | $29.92 | $79.59 | $162.97 |