- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.56 / $263.72 / $846.71
| Facility | | $87.56 | $263.72 | $846.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.08 / $266.30 / $327.48
| Professional | | $263.08 | $266.30 | $327.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.50 / $192.50 / $192.50
| Professional | | $192.50 | $192.50 | $192.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.53 / $64.53 / $64.53
| Facility | | $64.53 | $64.53 | $64.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.63 / $282.33 / $331.43
| Professional | | $158.63 | $282.33 | $331.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.70 / $272.70 / $272.70
| Facility | | $272.70 | $272.70 | $272.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.70 / $272.70 / $272.70
| Professional | | $272.70 | $272.70 | $272.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.73 / $180.53 / $352.92
| Facility | | $58.73 | $180.53 | $352.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $267.37 / $267.37
| Professional | | $267.37 | $267.37 | $267.37 |