- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.63 / $284.14 / $886.42
| Facility | | $108.63 | $284.14 | $886.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.63 / $108.63 / $112.98
| Professional | | $108.63 | $108.63 | $112.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.84 / $159.32 / $338.32
| Professional | | $144.84 | $159.32 | $338.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.38 / $244.79 / $526.14
| Facility | | $235.38 | $244.79 | $526.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.80 / $325.86 / $1,129.80
| Professional | | $107.80 | $325.86 | $1,129.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.57 / $294.42 / $294.42
| Professional | | $166.57 | $294.42 | $294.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.83 / $88.92 / $314.17
| Professional | | $60.83 | $88.92 | $314.17 |