- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.92 / $298.05 / $518.36
| Facility | | $127.92 | $298.05 | $518.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.94 / $127.92 / $156.74
| Professional | | $124.94 | $127.92 | $156.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.69 / $152.69 / $200.04
| Professional | | $152.69 | $152.69 | $200.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.13 / $190.62 / $540.41
| Professional | | $138.13 | $190.62 | $540.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.41 / $151.94 / $304.33
| Professional | | $138.41 | $151.94 | $304.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.02 / $167.12 / $377.70
| Professional | | $115.02 | $167.12 | $377.70 |