- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.44 / $217.94 / $520.08
| Facility | | $152.44 | $217.94 | $520.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.80 / $192.21 / $263.43
| Professional | | $116.80 | $192.21 | $263.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.93 / $197.65 / $409.51
| Facility | | $123.93 | $197.65 | $409.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.83 / $161.27 / $235.30
| Professional | | $102.83 | $161.27 | $235.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.55 / $57.70 / $60.52
| Facility | | $55.55 | $57.70 | $60.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.20 / $318.20 / $318.20
| Professional | | $318.20 | $318.20 | $318.20 |