- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.38 / $150.38 / $193.42
| Facility | | $150.38 | $150.38 | $193.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.61 / $153.71 / $219.14
| Professional | | $122.61 | $153.71 | $219.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.56 / $341.24 / $547.86
| Facility | | $268.56 | $341.24 | $547.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.87 / $155.87 / $258.81
| Professional | | $155.87 | $155.87 | $258.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.91 / $159.91 / $176.56
| Facility | | $159.91 | $159.91 | $176.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.74 / $116.74 / $347.43
| Professional | | $116.74 | $116.74 | $347.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.02 / $141.75 / $225.30
| Professional | | $107.02 | $141.75 | $225.30 |