- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.97 / $217.46 / $366.33
| Facility | | $173.97 | $217.46 | $366.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.33 / $217.46 / $223.98
| Professional | | $98.33 | $217.46 | $223.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.42 / $245.08 / $316.17
| Facility | | $205.42 | $245.08 | $316.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.05 / $209.88 / $370.23
| Facility | | $129.05 | $209.88 | $370.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $616.57 / $906.71
| Professional | | $200.00 | $616.57 | $906.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |