- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.63 / $144.46 / $878.32
| Facility | | $129.63 | $144.46 | $878.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.46 / $144.46 / $148.16
| Professional | | $144.46 | $144.46 | $148.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.20 / $194.46 / $255.58
| Professional | | $185.20 | $194.46 | $255.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.58 / $456.24 / $1,055.97
| Facility | | $336.58 | $456.24 | $1,055.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.46 / $185.20 / $222.24
| Facility | | $144.46 | $185.20 | $222.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.78 / $101.86 / $168.64
| Professional | | $77.78 | $101.86 | $168.64 |