- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.66 / $132.66 / $341.12
| Facility | | $132.66 | $132.66 | $341.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.66 / $132.66 / $178.14
| Professional | | $132.66 | $132.66 | $178.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.05 / $381.86 / $428.53
| Professional | | $315.05 | $381.86 | $428.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.65 / $219.83 / $276.42
| Professional | | $217.65 | $219.83 | $276.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.66 / $225.52 / $900.17
| Facility | | $132.66 | $225.52 | $900.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.58 / $85.18 / $322.17
| Professional | | $36.58 | $85.18 | $322.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.58 / $85.18 / $274.79
| Professional | | $36.58 | $85.18 | $274.79 |