- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.01 / $131.01 / $336.38
| Facility | | $131.01 | $131.01 | $336.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.01 / $181.97 / $336.38
| Professional | | $131.01 | $181.97 | $336.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.37 / $270.12 / $539.16
| Professional | | $155.37 | $270.12 | $539.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.68 / $252.68 / $252.68
| Facility | | $252.68 | $252.68 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.10 / $200.72 / $260.26
| Professional | | $194.10 | $200.72 | $260.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.86 / $323.50 / $525.67
| Professional | | $224.86 | $323.50 | $525.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.96 / $201.73 / $308.70
| Professional | | $157.96 | $201.73 | $308.70 |