- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $173.78 / $331.13
| Facility | | $128.82 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $141.25 / $173.78
| Professional | | $123.03 | $141.25 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $354.81 / $416.87
| Professional | | $245.47 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $269.15
| Professional | | $213.80 | $213.80 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $141.25 / $331.13
| Facility | | $112.20 | $141.25 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $218.78 / $371.54
| Professional | | $77.62 | $218.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $190.55 / $316.23
| Professional | | $77.62 | $190.55 | $316.23 |