- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.52 / $146.52 / $376.78
| Facility | | $146.52 | $146.52 | $376.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.52 / $146.52 / $196.76
| Professional | | $146.52 | $146.52 | $196.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.98 / $421.78 / $473.32
| Professional | | $347.98 | $421.78 | $473.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.37 / $242.77 / $305.26
| Professional | | $240.37 | $242.77 | $305.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.52 / $249.08 / $994.27
| Facility | | $146.52 | $249.08 | $994.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.91 / $184.38 / $355.84
| Professional | | $87.91 | $184.38 | $355.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.91 / $184.38 / $293.05
| Professional | | $87.91 | $184.38 | $293.05 |