- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.98 / $310.55 / $747.08
| Facility | | $198.98 | $310.55 | $747.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.27 / $167.58 / $287.67
| Professional | | $133.27 | $167.58 | $287.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.69 / $273.81 / $588.25
| Facility | | $159.69 | $273.81 | $588.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.94 / $156.18 / $266.37
| Professional | | $131.94 | $156.18 | $266.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.64 / $266.29 / $408.58
| Facility | | $119.64 | $266.29 | $408.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.00 / $1,381.00 / $1,381.00
| Professional | | $1,381.00 | $1,381.00 | $1,381.00 |