- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.76 / $218.76 / $273.45
| Facility | | $218.76 | $218.76 | $273.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.45 / $273.45 / $273.45
| Professional | | $273.45 | $273.45 | $273.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $117.71 / $158.36
| Facility | | $97.00 | $117.71 | $158.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.38 / $135.38 / $173.08
| Professional | | $135.38 | $135.38 | $173.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.76 / $137.51 / $526.67
| Facility | | $39.76 | $137.51 | $526.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.22 / $262.13 / $262.13
| Facility | | $24.22 | $262.13 | $262.13 |