- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.43 / $369.44 / $369.44
| Professional | | $336.43 | $369.44 | $369.44 |
- 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
- $168.50 / $168.50 / $210.63
| Professional | | $168.50 | $168.50 | $210.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.44 / $369.44 / $472.88
| Facility | | $369.44 | $369.44 | $472.88 |
- 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 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $200.00
| Professional | | $200.00 | $200.00 | $200.00 |