- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.08 / $462.81 / $511.30
| Facility | | $385.08 | $462.81 | $511.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.13 / $286.13 / $286.13
| Facility | | $286.13 | $286.13 | $286.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $16.00 / $16.00
| Professional | | $16.00 | $16.00 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.69 / $152.69 / $171.28
| Facility | | $152.69 | $152.69 | $171.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $16.00 / $16.00
| Professional | | $16.00 | $16.00 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $25.00
| Professional | | $17.00 | $20.00 | $25.00 |