- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $371.54 / $602.56
| Facility | | $41.69 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $602.56
| Professional | | $30.20 | $47.86 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $602.56
| Professional | | $223.87 | $380.19 | $602.56 |
- 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
- $234.42 / $346.74 / $549.54
| Professional | | $234.42 | $346.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $57.54 / $89.13
| Professional | | $39.81 | $57.54 | $89.13 |