- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.37 / $254.11 / $382.35
| Facility | | $136.37 | $254.11 | $382.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $140.19 / $355.46
| Professional | | $127.45 | $140.19 | $355.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.53 / $452.39 / $748.01
| Facility | | $114.53 | $452.39 | $748.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.01 / $122.20 / $810.73
| Professional | | $84.01 | $122.20 | $810.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $127.45
| Facility | | $127.45 | $127.45 | $127.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $127.45
| Professional | | $127.45 | $127.45 | $127.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.24 / $166.63 / $198.57
| Facility | | $126.24 | $166.63 | $198.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.24 / $126.24 / $126.24
| Professional | | $126.24 | $126.24 | $126.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.45 / $127.45 / $127.45
| Professional | | $127.45 | $127.45 | $127.45 |