- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.00 / $362.81 / $380.96
| Professional | | $225.00 | $362.81 | $380.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.91 / $161.38 / $634.67
| Facility | | $139.91 | $161.38 | $634.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.49 / $104.49 / $130.61
| Professional | | $104.49 | $104.49 | $130.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $225.00 / $288.00
| Facility | | $225.00 | $225.00 | $288.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78.00
| Professional | | $55.00 | $55.00 | $78.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.89 / $429.29 / $524.42
| Facility | | $307.89 | $429.29 | $524.42 |