- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.72 / $140.72 / $440.70
| Facility | | $140.72 | $140.72 | $440.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $162.77 / $904.89
| Professional | | $84.44 | $162.77 | $904.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.10 / $154.47 / $175.92
| Professional | | $104.10 | $154.47 | $175.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.72 / $140.72 / $140.72
| Facility | | $140.72 | $140.72 | $140.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.63 / $194.68 / $303.19
| Professional | | $85.63 | $194.68 | $303.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.24 / $138.40 / $263.31
| Professional | | $52.24 | $138.40 | $263.31 |