- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.55 / $284.55 / $889.56
| Facility | | $284.55 | $284.55 | $889.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.30 / $272.52 / $306.63
| Professional | | $245.30 | $272.52 | $306.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.95 / $320.58 / $368.67
| Facility | | $283.95 | $320.58 | $368.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.30 / $245.30 / $245.30
| Professional | | $245.30 | $245.30 | $245.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $188.11 / $240.78
| Professional | | $60.00 | $188.11 | $240.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.85 / $269.83 / $269.83
| Professional | | $242.85 | $269.83 | $269.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.30 / $245.30 / $245.30
| Professional | | $245.30 | $245.30 | $245.30 |