- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.54 / $422.60 / $913.73
| Facility | | $285.54 | $422.60 | $913.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.54 / $285.54 / $380.72
| Professional | | $285.54 | $285.54 | $380.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.47 / $250.23 / $492.68
| Facility | | $247.47 | $250.23 | $492.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.37 / $437.37 / $546.71
| Professional | | $437.37 | $437.37 | $546.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.43 / $308.38 / $1,275.41
| Facility | | $228.43 | $308.38 | $1,275.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.90 / $159.90 / $380.72
| Professional | | $159.90 | $159.90 | $380.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.90 / $159.90 / $243.66
| Professional | | $159.90 | $159.90 | $243.66 |