- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.14 / $120.14 / $374.84
| Facility | | $120.14 | $120.14 | $374.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.14 / $120.14 / $120.14
| Professional | | $120.14 | $120.14 | $120.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.16 / $236.51 / $447.29
| Facility | | $136.16 | $236.51 | $447.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.43 / $63.43 / $127.65
| Professional | | $63.43 | $63.43 | $127.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.14 / $150.18 / $334.29
| Facility | | $120.14 | $150.18 | $334.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.14 / $150.18 / $180.21
| Professional | | $120.14 | $150.18 | $180.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.15 / $125.15 / $132.77
| Professional | | $125.15 | $125.15 | $132.77 |