- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $562.34 / $724.44
| Facility | | $478.63 | $562.34 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $812.83
| Professional | | $30.20 | $44.67 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $588.84 / $691.83
| Professional | | $524.81 | $588.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $562.34 / $724.44
| Professional | | $316.23 | $562.34 | $724.44 |
- 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 |