- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $575.44
| Facility | | $165.96 | $245.47 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $190.55 / $275.42
| Professional | | $125.89 | $190.55 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $234.42 / $457.09
| Facility | | $186.21 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $162.18 / $257.04
| Professional | | $114.82 | $162.18 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $67.61 / $81.28
| Facility | | $66.07 | $67.61 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $416.87 / $416.87
| Professional | | $74.13 | $416.87 | $416.87 |