- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.51 / $305.64 / $660.84
| Facility | | $206.51 | $305.64 | $660.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.51 / $206.51 / $245.44
| Professional | | $206.51 | $206.51 | $245.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.98 / $178.98 / $735.61
| Facility | | $178.98 | $178.98 | $735.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.34 / $335.34 / $401.77
| Professional | | $335.34 | $335.34 | $401.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.76 / $268.45 / $462.59
| Facility | | $203.76 | $268.45 | $462.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.65 / $115.65 / $413.03
| Professional | | $115.65 | $115.65 | $413.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.65 / $115.65 / $176.22
| Professional | | $115.65 | $115.65 | $176.22 |