- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.70 / $249.14 / $353.85
| Facility | | $234.70 | $249.14 | $353.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.13 / $249.14 / $361.07
| Professional | | $190.13 | $249.14 | $361.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.97 / $645.70 / $907.62
| Facility | | $377.97 | $645.70 | $907.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.75 / $308.32 / $308.32
| Professional | | $257.75 | $308.32 | $308.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.51 / $203.51 / $203.51
| Facility | | $203.51 | $203.51 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.56 / $203.51 / $203.51
| Professional | | $148.56 | $203.51 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.32 / $216.64 / $260.55
| Professional | | $108.32 | $216.64 | $260.55 |