- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $320.98 / $356.06
| Facility | | $175.40 | $320.98 | $356.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.57 / $320.98 / $356.06
| Professional | | $138.57 | $320.98 | $356.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $175.40 / $175.40
| Facility | | $175.40 | $175.40 | $175.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.40 / $175.40 / $175.40
| Professional | | $175.40 | $175.40 | $175.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.01 / $133.05 / $267.39
| Facility | | $114.01 | $133.05 | $267.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.06 / $139.44 / $300.27
| Professional | | $75.06 | $139.44 | $300.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.67 / $105.24 / $268.88
| Professional | | $73.67 | $105.24 | $268.88 |