- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.02 / $521.60 / $578.61
| Facility | | $285.02 | $521.60 | $578.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.17 / $313.52 / $547.26
| Professional | | $225.17 | $313.52 | $547.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.02 / $285.02 / $285.02
| Facility | | $285.02 | $285.02 | $285.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.02 / $285.02 / $285.02
| Professional | | $285.02 | $285.02 | $285.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.36 / $161.66 / $216.21
| Facility | | $82.36 | $161.66 | $216.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.56 / $129.74 / $409.39
| Professional | | $51.56 | $129.74 | $409.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.88 / $119.71 / $315.24
| Professional | | $57.88 | $119.71 | $315.24 |