- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.88 / $385.73 / $390.22
| Facility | | $218.88 | $385.73 | $390.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.38 / $164.82 / $419.80
| Professional | | $139.38 | $164.82 | $419.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.36 / $207.71 / $331.55
| Professional | | $138.36 | $207.71 | $331.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.91 / $233.02 / $459.86
| Professional | | $185.91 | $233.02 | $459.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.86 / $264.55 / $433.56
| Professional | | $135.86 | $264.55 | $433.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.50 / $326.41 / $431.25
| Professional | | $228.50 | $326.41 | $431.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.19 / $241.85 / $463.64
| Professional | | $151.19 | $241.85 | $463.64 |