- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.48 / $350.36 / $350.36
| Facility | | $191.48 | $350.36 | $350.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.41 / $126.37 / $204.27
| Professional | | $103.41 | $126.37 | $204.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.59 / $143.08 / $217.67
| Professional | | $105.59 | $143.08 | $217.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.83 / $283.67 / $302.19
| Facility | | $37.83 | $283.67 | $302.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.91 / $177.81 / $401.27
| Professional | | $94.91 | $177.81 | $401.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.61 / $178.95 / $262.83
| Professional | | $127.61 | $178.95 | $262.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.40 / $188.78 / $397.02
| Professional | | $109.40 | $188.78 | $397.02 |