- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.47 / $251.92 / $389.26
| Facility | | $148.47 | $251.92 | $389.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.43 / $106.06 / $118.25
| Professional | | $91.43 | $106.06 | $118.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.35 / $124.35 / $124.35
| Professional | | $124.35 | $124.35 | $124.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.77 / $199.68 / $276.62
| Facility | | $107.77 | $199.68 | $276.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.53 / $121.91 / $164.00
| Facility | | $97.53 | $121.91 | $164.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.20 / $90.31 / $609.54
| Professional | | $51.20 | $90.31 | $609.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.20 / $73.15 / $182.87
| Professional | | $51.20 | $73.15 | $182.87 |