- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.49 / $340.69 / $890.75
| Facility | | $88.49 | $340.69 | $890.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.29 / $96.74 / $416.62
| Professional | | $74.29 | $96.74 | $416.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.76 / $447.76 / $447.76
| Professional | | $447.76 | $447.76 | $447.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.79 / $186.40 / $529.91
| Professional | | $97.79 | $186.40 | $529.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.01 / $338.39 / $802.25
| Professional | | $198.01 | $338.39 | $802.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.17 / $296.81 / $431.73
| Professional | | $241.17 | $296.81 | $431.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.31 / $377.76 / $498.08
| Professional | | $242.31 | $377.76 | $498.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.66 / $103.42 / $262.81
| Professional | | $75.66 | $103.42 | $262.81 |