- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.53 / $238.58 / $590.95
| Facility | | $186.53 | $238.58 | $590.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.50 / $186.53 / $195.83
| Professional | | $127.50 | $186.53 | $195.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.45 / $219.45 / $230.39
| Professional | | $219.45 | $219.45 | $230.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.17 / $215.17 / $215.17
| Professional | | $215.17 | $215.17 | $215.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.56 / $94.40 / $207.35
| Professional | | $65.56 | $94.40 | $207.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.12 / $230.39 / $230.54
| Professional | | $192.12 | $230.39 | $230.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.25 / $182.25 / $182.25
| Professional | | $182.25 | $182.25 | $182.25 |