- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.65 / $502.85 / $964.80
| Facility | | $232.65 | $502.85 | $964.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.94 / $317.60 / $317.60
| Professional | | $181.94 | $317.60 | $317.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $376.00
| Professional | | $60.00 | $60.00 | $376.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.76 / $116.76 / $116.76
| Professional | | $116.76 | $116.76 | $116.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.22 / $336.66 / $706.45
| Facility | | $300.22 | $336.66 | $706.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.53 / $329.53 / $329.53
| Professional | | $329.53 | $329.53 | $329.53 |