- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.74 / $385.77 / $521.12
| Facility | | $210.74 | $385.77 | $521.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.19 / $105.56 / $134.04
| Professional | | $39.19 | $105.56 | $134.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.62 / $158.34 / $175.18
| Facility | | $151.62 | $158.34 | $175.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.55 / $96.55 / $245.03
| Professional | | $96.55 | $96.55 | $245.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.27 / $307.27 / $540.15
| Facility | | $307.27 | $307.27 | $540.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.06 / $189.65 / $429.76
| Professional | | $93.06 | $189.65 | $429.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.07 / $108.68 / $254.68
| Professional | | $54.07 | $108.68 | $254.68 |