- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $309.03 / $446.68
| Facility | | $41.69 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $501.19
| Professional | | $30.20 | $47.86 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $501.19
| Professional | | $186.21 | $316.23 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $275.42 / $446.68
| Professional | | $186.21 | $275.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $57.54 / $89.13
| Professional | | $39.81 | $57.54 | $89.13 |