- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.40 / $236.89 / $284.27
| Facility | | $155.40 | $236.89 | $284.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.13 / $153.50 / $155.40
| Professional | | $142.13 | $153.50 | $155.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.46 / $255.84 / $284.27
| Facility | | $208.46 | $255.84 | $284.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.41 / $227.41 / $255.84
| Professional | | $227.41 | $227.41 | $255.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.97 / $227.41 / $568.48
| Facility | | $153.97 | $227.41 | $568.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.72 / $272.06 / $913.44
| Professional | | $29.72 | $272.06 | $913.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.75 / $36.53 / $113.71
| Professional | | $19.75 | $36.53 | $113.71 |