- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.35 / $196.87 / $281.27
| Facility | | $171.35 | $196.87 | $281.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.33 / $171.35 / $281.27
| Professional | | $135.33 | $171.35 | $281.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.56 / $54.56 / $54.56
| Facility | | $54.56 | $54.56 | $54.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.30 / $183.04 / $183.04
| Professional | | $138.30 | $183.04 | $183.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.73 / $105.13 / $120.74
| Facility | | $63.73 | $105.13 | $120.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.57 / $204.45 / $273.22
| Professional | | $134.57 | $204.45 | $273.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.68 / $173.16 / $264.31
| Professional | | $114.68 | $173.16 | $264.31 |