- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $346.74 / $446.68
| Facility | | $302.00 | $346.74 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $512.86
| Professional | | $30.20 | $45.71 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $446.68 / $512.86
| Professional | | $380.19 | $446.68 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $316.23 / $416.87
| Professional | | $181.97 | $316.23 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $66.07 / $97.72
| Professional | | $50.12 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $97.72
| Professional | | $50.12 | $70.79 | $97.72 |