- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.66 / $137.66 / $353.49
| Facility | | $137.66 | $137.66 | $353.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.66 / $223.94 / $912.60
| Professional | | $137.66 | $223.94 | $912.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.43 / $210.49 / $560.19
| Professional | | $161.43 | $210.49 | $560.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.83 / $373.38 / $373.38
| Facility | | $312.83 | $373.38 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.34 / $317.37 / $487.13
| Professional | | $208.34 | $317.37 | $487.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.31 / $339.95 / $552.41
| Professional | | $236.31 | $339.95 | $552.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.12 / $209.60 / $320.74
| Professional | | $164.12 | $209.60 | $320.74 |