- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $398.11
| Facility | | $218.78 | $275.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $275.42 / $275.42
| Professional | | $104.71 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $181.97 / $275.42
| Professional | | $169.82 | $181.97 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $489.78 / $741.31
| Facility | | $39.81 | $489.78 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $281.84 / $288.40
| Facility | | $33.88 | $281.84 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $213.80 / $426.58
| Professional | | $39.81 | $213.80 | $426.58 |