- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.47 / $330.53 / $336.82
| Facility | | $185.47 | $330.53 | $336.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.20 / $140.40 / $278.77
| Professional | | $118.20 | $140.40 | $278.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.97 / $174.45 / $280.70
| Professional | | $114.97 | $174.45 | $280.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.47 / $198.99 / $390.49
| Professional | | $155.47 | $198.99 | $390.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.69 / $221.39 / $363.26
| Professional | | $113.69 | $221.39 | $363.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.03 / $279.97 / $367.50
| Professional | | $112.03 | $279.97 | $367.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.83 / $206.78 / $425.22
| Professional | | $128.83 | $206.78 | $425.22 |