- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $794.33
| Facility | | $190.55 | $331.13 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $169.82
| Professional | | $114.82 | $144.54 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $616.60
| Facility | | $204.17 | $295.12 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $162.18
| Professional | | $114.82 | $114.82 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $112.20 / $288.40
| Facility | | $66.07 | $112.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $398.11 / $398.11
| Professional | | $158.49 | $398.11 | $398.11 |