- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $173.78 / $245.47
| Facility | | $151.36 | $173.78 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $169.82 / $218.78
| Professional | | $144.54 | $169.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $151.36 / $407.38
| Professional | | $112.20 | $151.36 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $645.65 / $1,621.81
| Facility | | $288.40 | $645.65 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $204.17 / $257.04
| Professional | | $165.96 | $204.17 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $177.83 / $213.80
| Facility | | $169.82 | $177.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $426.58
| Professional | | $173.78 | $251.19 | $426.58 |